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SAH JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. O, Box 2009 <br /> Stockton. CA 95201 <br /> (209) 466-6181 <br /> Jogi Khanna, M.O. . Health Officer <br /> • NATIONAL MEDICAL ENTERPRISES . IIANTE12 <br /> 11620 WILSHIRE BLVD . MANTECA HOSPITAL <br /> IAS ANGELES , CA 90025 . 1205 E NORTH ST <br /> MANTECA, CA 95336 <br /> 8i l l inq statement for 1 87 Pt Underground Tank Faci l i t . <br /> Y <br /> Statement Date: MAY 1, 1987 <br /> Due: JUNE 1, 1987 <br /> Facility <br /> S 100.00 <br /> Container N `Status �~ <br /> State surcharges @ S56 per tank x <br /> Subtotal of permit fees: <br /> $150 <br /> Additional Billings or Credits <br /> ----------------- <br /> (e jg <br /> TOTAL FEES DUE : 5150 . 00 <br /> Penalties will be added <br /> Notify the San Joaquin Local health 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 /> San Joaquin Local health District <br /> k Environmental Health permit/Services <br /> A - Active P. 0. Box 2009, Stockton. CA 95201 <br /> TC - Temporary Closur-r <br /> PC - Permanent Closr�rr1 <br />