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P <br /> SAN JOAQOIH LOCAL HEALTH 41ST xI T <br /> Hazelton Ave. , P. 0. B° 2009 <br /> 1501 E. Stockton, CA 95201 <br /> (209) 456-5781 <br /> Jogi Khanna, M.D. , Health Officer <br /> • TIKIL12 <br /> • TIKI LAGUN RESORT & MARINA <br /> HORS <br /> RANF 12988 W MC DONALD RD. <br /> 1-2988 W gC DONALD RD . <br /> • STOCKTON , CA 95206 <br /> STOCKTON , CA 95206 <br /> Billing statement for <br /> 1887 Permit Underground Tank Facility. <br /> Statement Date: ?,4arch 15 1987 <br /> Due: <br /> A ril 15L9 7 <br /> $$ 100 <br /> Facility <br /> Container # *Status , <br /> �l <br /> State surcharges @ $56 per tank <br /> Subtotal of permit fees: <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: <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 /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />