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lr <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 FHCON49F & H CONSTRUCTION <br /> 4945 WATERLOO RD. . 4945 WATERLOO RD. <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit , Underground Tank Facility. <br /> Statement Date: APRIL 15, 1987 <br /> Due: MAY 15, 1987 <br /> Facility $ 100.00 <br /> Container # *Status <br /> 1 A $ 50.Q0 <br /> 2 A --5"�i <br /> S 00 PAYMENT <br /> -- � RECEIVED <br /> JON 3 01987 7f <br /> �-`— <br /> State surcharges @ $56 per tank x = tNVIRQNMENTAL HJALT14PERMIT/SERVICES <br /> Subtotal of permit fees: <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: i 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 />