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0% 6 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> J09i Khanna, M.D. , Health Officer <br /> T & T TRUCKING TTTRUII <br /> 11396 NORTH HWY 99 T & T TRUCKING <br /> LODI , CA 95240 11396 NORTH HWY99 <br /> LODI , CA 95240 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: MAY 1 , 1987 <br /> Due' JUNE 1 , 1987 <br /> Facility <br /> $ 100.00 <br /> Container # *Status <br /> 1 <br /> 2 —L' 50.00 <br /> 50.00 P,A YMIKNT <br /> 50.00 RECEIVED <br /> MAY 2 19V <br /> ENVIRONMENTAL HEALTH <br /> State surcharges @ $56 per tank x - PERMIT/SERVICES <br /> Subtotal of permit fees: <br /> $ 250.00 <br /> Additional Billings or Credits <br /> S <br /> TOTAL FEES DUE: <br /> Penalties will be added ----�_ <br /> Notify the San Joaquin Local i{ealth District <br /> past due date as shown: of any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> 30 days - 100% of Base Fee and approval of facility. <br /> Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local diealth District <br /> A - TEnvironmental Health Permit/Services <br /> TC - Temporary Closure P. 0. Box 2009, Stockton , CA 95201 <br /> E'C -- Permanent Closrjre <br />