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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3425 <br /> Jogi Khanna, M.D. , Health Officer <br /> VANVLI7 <br /> JOHN VAN VLIET JOHN VAN VLIET <br /> 17782 E. SIEDNER ROAD JVrMEF-q&EX e1D <br /> ESCALON', CA 96320 ESCALON, CA 9532.0 <br /> Billing Statefi,ent For 1989 Permit, Underground Tank Facility . <br /> Statement Date July 1 , 1989 <br /> Payment. Due Date; August. 1 , 1989 <br /> Facility Feet 100.00 <br /> Container Number; 0001 S0.00 <br /> TOTAL FEES DUE $150.00 <br /> NOTES; <br /> Notify the Sar, Joaquin Local <br /> Health District of any <br /> corrections or changes <br /> necessary . Your permit will <br /> be mailed upon receipt of <br /> payment and approval of <br /> facility . <br /> Return payment. along with one <br /> copy of this statement to; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> P.O. BOX 2009 <br /> STOCKI'ON, CA 95201 <br /> Penalties will be, added after <br /> due date as shown; <br /> 30 days.- 100Z of Base Fee <br />