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•• •� <br /> SAN JUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> J09i Khanna, H,D, , Health Officer <br /> MANTE 12 <br /> • NATIONAL MEDICAL ENTERPRISES MANTECA HOSPITAL <br /> 11620 WILSHIRE BLVD 1205 E NORTH ST <br /> LOS ANGELES , CA 90025 MANTECA, CA 95336 <br /> Billing statement for 287 Permit Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 <br /> Due: JUNE 1, 1987 <br /> Facility S 100.00 <br /> Container # Status <br /> _ A 0•— PAYMENT <br /> RECEIVED <br /> MAY 2 i 1957 �k <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $150 <br /> Additional Billings or Credits <br /> S <br /> TOTAL FEES DUE : - - 5150 . 00 <br /> Penalties will be added 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 - 100X of Base Fee <br /> days and approval of facility. <br /> Return payment along with one copy of this <br /> San Joaquin Local health District <br /> Environmental Ilealth Perinit/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />