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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> • SANJ044 <br /> SAN JOAQUIN COUNTY - SAN JOAQUIN COUNTY-WILSON WAY COMPLE) <br /> 222 E. WEBER AVENUE •444 S. WILSON WAY <br /> STOCKTON, CA 95202 • STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: SEPTEMBER 3, 1987 <br /> Due: OCTOBER 3, 1987 <br /> Facility $ 100 <br /> Container # *Status _ <br /> --2-- T_ 1 50 <br /> 3 1 50 PAYMENT <br /> 0 { ECEfVED <br /> SEP 2 51987 '�:N!x <br /> State surcharges @ $56 per tank x _ _ $ ENVIRONMENTAL HEALTH <br /> PERMIT ISERVICES <br /> Subtotal of permit fees: $400.00 <br /> Additional Billings or Credits <br /> _(overpayment of 1986 fees) - $ 30.00 <br /> TOTAL FEES DUE: 5370.00 <br /> Penalties will be added Notify the San Joaquin Local Health <br /> after due date as shown: of any corrections or changes necessar!- _ <br /> Permit will be mailed upon receipt of <br /> and approval of facility. <br /> 30 days - 100% of Base Fee Return payment along with one copy <br /> statement to: <br /> San Joaquin Local Health District <br /> Environmental Health Permit/Services <br /> P. 0. Box 2009, Stockton, CA 95201 <br /> A - Active - - <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />