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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 /> CITY OF ESCALON ESCAL21CITY OF ESCALON <br /> P. 0. BOX 248 2103 MAIN ST. <br /> ESCALON, CA 95320 lESCALON, CA 95320 <br /> Billing statement for 1987 Permit , Underground Tank Facility. <br /> Statement hate: Mar t 15 1987 <br /> Due: A rix 15 87 <br /> Facility $ 100 <br /> Container # *Status <br /> x A 50 <br /> 2 A $50 -- <br /> $ PAYMENT <br /> RECEIVED <br /> $ MAY 4 1987 <br /> $ .ENVIRONMENTAL HEALTH <br /> State surcharges @ $56 per tank x _ _ PERMITISERVICES <br /> 'rrf <br /> Subtotal of permit fees: $200 <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $200.00 <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 /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />