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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6181 <br /> Jogi Khanna, M.D. , Health Officer <br /> • HMTRA70 <br /> - H & M TRANSPORT, INC . • H & M TRANSPORT, INC . <br /> P. 0 . BOX H • 707 ROTH RD. <br /> FRENCH CAMP , CA 95231 • FRENCH CAMP , CA 95231 <br /> Billing statement for 1981 Permit Underground Tank Facility. <br /> Statement Date: March 15, 1987 <br /> Due: April 15 <br /> Facility $ 100 <br /> Container # *Status <br /> 1 A $ _ <br /> 3 -A $ 50- <br /> 4 A � PAYMENT— <br /> $ PAYMENT <br /> RECEIVED <br /> $ MAY 4 1987 <br /> State surcharges @ $56 per tank x _ _ $ , 'jI <br /> ENVIRONMENTAL HEALTH <br /> Subtotal of permit fees: $ 30(} PERMITISERVICES <br /> Additional Billings or Credits <br /> 5 <br /> TOTAL FEES DUE: $ 300.00 <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 /> A - Active <br /> P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />