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6 0 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> .SOUTH01 (SPRR) <br /> ' <br /> <br /> , LODI , CA 95240 <br /> Billing statement for 1987 PERMIT , Underground Tank Facility. <br /> Statement Date: JULY 21, 1987 <br /> Due: AUGUST 21, 1987 <br /> Facility $ 100.00 <br /> Container # Status <br /> 1 A $ 50.00 <br /> State surcharges @ $56 per tank x _ _ $�_ <br /> Subtotal of permit fees: $ 150.00 <br /> Additional Billings or Credits <br /> Debit Balance forward-1986 $ 116.00 <br /> TOTAL FEES DUE: $ 266.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after due date as shown: of any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> and approval of facility. <br /> 30 days - 100% of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District <br /> Environmental Health Permit/Services <br /> P. 0. Box 2009, Stockton, CA 95201 <br />