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• r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> J09i Khanna, M.D. , Health Officer <br /> ' <br /> <br /> • 645 N. STOCKTON ST. <br /> • LODI , CA 95240 <br /> Billing statement for 1987 Permit <br /> Underground Tank Facility. <br /> Statement Date: APRIL 15, 1987 <br /> Due: MAY 15, 1987 <br /> Facility $ 100.00 <br /> Container N Status <br /> —L A $ 5O.00 n t 4 <br /> (i6-/ Iis­� <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ <br /> ign <br /> Additional Billings or Credits — <br /> $ 9� p� <br /> TOTAL FEES DUE: .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 days - 100% of Base Fee and approval of facility. <br /> 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 P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />