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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton Ave. . P. 0. Box 2009 PAYMENT <br /> Stockton, CA 95201 RECEIVED <br /> (209) 466-6781 JUN Z � 19t),j <br /> Jogi Khanna , M.D. , Health Officer ENVIRONMENTAL <br /> PERMIT ERVICESALTH <br /> KMART21 <br /> K-MART ENTERPRISES <br /> K-MART ENTERPRISES 2180 E. MARIPOSA ROAD <br /> <br /> <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: JUNE 1, 1987 <br /> Due : JULY 1, 1987 <br /> Facility S 100.00 <br /> Container M •Status <br /> 1 A 5_50__O 0 <br /> State surcharges @ S56 per tank x = S <br /> Subtotal of permit fees : S 150.00 <br /> Additional Billings or Credits <br /> Balance- from 1986 S 116.00 S26b.00 7l` / <br /> LO , <br /> -TOTAL FEES DUE: a <br /> Penalties will be added Notify the San Joaquin Local Health DiSCrict <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 - 100% of Base FCC Return payment along with one COPY of this <br /> statement to: <br /> San Joaquin Local HCalth District <br /> Environmental Health Perini t/Services <br /> • P. 0. Box 2009. Stockton, CA 95201 <br /> A - Active <br /> IC - Temporary Closul'(• <br /> I'I - Pvcr'.i fill III Clo•,u r • <br />