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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 /> . MKTFA19 <br /> M.K .T . FARMS . M .K. T . FARMS (SHOP) <br /> 18666 MELLO AVE . . 19201 MELLO AVE. <br /> RIPON, CA 95366 . RIPON , CA 95366 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: March 15 1987 <br /> Due: April 15 1987 <br /> Facility $ 100 PAYMENT <br /> RECEIVED <br /> Container # *Status JILL 2 4--j 1987 <br /> 1 A $ 50 <br /> 2 A $ 50 <br /> 3 A 5$ 0 - ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $250 <br /> Additional Billings or Credits <br /> S _ <br /> TOTAL FEES DUE: $ 250.00 <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 /> P. 0. Box 2009, Stockton , CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />