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TSA•JOA UIN LOCAL HEALTH DISTRICT <br /> C <br /> 1601 E. Hazelton Ave. . P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6181 . <br /> Jogi Khanna, M.O. , Health Officer <br /> LANCA12 <br /> BILL LANCASTER FORMERLY LANCASTER'S VAN & STORAGE <br /> P. 0. BOX 936 1250 N. MAIN <br /> SONORA, CA 95370 MANTECA, CA 95336 <br /> Billing statement for 1981 Permit . Underground Tank Facility, <br /> Statement Date: JUNE 3, 1987 <br /> Due : JUNE 30, 1987 <br /> Facility S <br /> Container N Status PAYMENT <br /> RECEIVED <br /> SEP 2 1987 <br /> .ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> State surcharges 0 S56 per tank x <br /> Subtotal of permit fees : 590.00 PERMANENT CLOSURE <br /> Additional Billings or Credits <br /> Additional fee from 1986 510.00 <br /> -TOTAL FEES DUE: S 100.00 <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 /> and approval of facility. <br /> 30 days - 1001 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 /> A - Active P. 0. Box 2009. Stockton . CA 95201 <br /> TC - Temoorary Closure <br /> 1'( - I'rr'ct.lrlrrrl C1�)sur'r• <br />