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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> • <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 /> TIME OIL COMPANY . JACKPI5 <br /> 2737 W COMMODORE WAY . JACKPOT <br /> SEATTLE, WA 98199 , 1554 W YOSEMITE <br /> MANTECA, CA 95336 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: _MAY 7 1A87 <br /> Due: June 1, 1987 <br /> Facility $100 <br /> Container # Status <br /> • 1 A $.n <br /> 3 A $Fn <br /> 3 A $.n <br /> State surcharges @ $56 per tank x = $ <br /> Subtotal of permit fees: $ 250 <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: $250. 00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after due date as shown: of any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> and approval of facility. <br /> 30 days - 100% of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District <br /> • Environmental Health Permit/Services <br /> P. 0. Box 2009, Stockton, CA 95201 <br />