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SAN JOAQUIN LOCA H :ALTH DISTRICT <br /> r 1601 E. Hazelton Aye. , P. 0, Box 2009 <br /> Stockton, C 95201 <br /> (209) 4 -6781 <br /> Jogi Khanna, M.O. , Health Officer <br /> UNION43 <br /> UNION OIL #0187 UNION OIL #0187 <br /> 2175 N. CALIFONRIA BLVD. SUITE 650 437 E. MINER AVENUE <br /> WALNUT CREEK, CA 94596 STOCKTON, CA 95202 <br /> Billing statement for 1987 'Permit underground Tank Faciiit'y. <br /> Statement Date: _JUNE 3, 1987 , <br /> Due.- JUNE 30, 1987 <br /> Facility S 100.00 <br /> Container N +Status <br /> 1 v A 50 <br /> 2 _ A 1 50.00 <br /> 3 A 50.00 <br /> hWaved IM <br /> State surcharge-, @ S56 per tank x <br /> Subtotal of permit fens: 5250,00 <br /> Additional Billings or Credits <br /> Additional tee from 1986 $10.00 S 10.00 <br /> -TOTAL FEES DUE: S-260-00-- <br /> Penalties <br /> ,2 _ <br /> Penalties will be added Notify tttie_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 Ilase Fee Return payn%ent along with one cotry of *hi -, <br /> Staterr►ent to: <br /> San Joaquin Local tieaitti Wstrict <br /> Environmental Health Permit/Services <br /> A - Active <br /> P. 0. Box 2.009. Stockton . C1PN�'*IECNT <br /> - Temporary TemorTemporaryry Closut�,r � RECEIVED� �,�� <br /> t,,,F.,.,1f,I•1 Clrr•�i„ 1 JUL 2 11987 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br />