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SAN JOAQUIN LOCAL HEALTH OISTRICT <br /> 1601 E. Hazelton Ave. . P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna , M.O. , Health Officer <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 $ 100.00 <br /> Container # •Status <br /> 1 A 50.00 <br /> State surcharges @ S56 per tank x <br /> Subtotal of permit fees: S 150.00 <br /> Additional Billings or Credits <br /> Balance from 1986 —_ S 116.00 r7 <br /> -TOTAL FEES DUE: S—_266 nn <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> Pest 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 th's <br /> statement to: <br /> San Joaquin Local Hcalth District <br /> Environmental Health PeriniL/Services <br /> • P. 0. Box 2009. Stockton, CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> 1'f - I'erm.ln.'nI Cl�r.ur. <br />