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T <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 /> • F & H CONSTRUCTION FHCON49 <br /> 4945 WATERLOO RD. F & H CONSTRUCTION <br /> STOCKTON, CA 95205 4945 14ATERLOO RD. <br /> STOCKTON, CA 95205 <br /> Billing statement for 1987Permit Underground Tank Facility, <br /> Statement Date: APRIL 15, 1987 PAYMENT <br /> Due: MAY 15, 1987 REC—EIV ED <br /> Facility JUN 301987 <br /> $ loo.00 <br /> Container pENVIRONMENTAL HEALTH <br /> *Status PERMITISERVICES <br /> 3A 50.00 <br /> 3 A c 35THI0 F and H CG yjj.UCTj0N <br /> 3b�60 <br /> APR 16 1987 <br /> y4 Checkeo ay,____` <br /> O.K. To Pay, <br /> State surcharges @ $56 per tank x = <br /> Subtotal of permit fees: <br /> g ZZ_59.Q0 <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: 5250.00 <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 />