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'ROAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1 . Hazelton Ave. . P_ 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <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 1981 Permit . Underground Tank Facility. <br /> Statement Date: JUNE 3 198 <br /> Due : JUNE 30 1987 <br /> Facility S 100.00 <br /> Container M 'Status <br /> 1A 5.�QO <br /> . _ A 5Q � <br /> State surcharges @ SS6 per tank x 7 <br /> Subtotal of permit fc1­s : 525MO <br /> Add r t i ono 1 Ili I i r nth-, or Credits <br /> _Additional fee from 1986 _$10-AO S 10.00 <br /> -TOTAL FEES DUL : 5-260-04-- <br /> Penalties will be added 140LIfy the San Joaquin Local Ilea ILh District <br /> past due date as shot-4n : of any corrections or ctranges necessary <br /> Permit will tic mailed upon receipt of payment. <br /> and approval of facility. <br /> 30 ddy5 - low. 01 oo-.c i (.(.. <br /> Return payn+tnl d Iony with one to{ry of .ht; <br /> statement to: <br /> San Joaquin Local Health District <br /> Cnvi ronrnenta l Health Perini t/Sery ices <br /> A Active <br /> P. 0. Box 2009. Stockton , CA 95201 <br /> - <br /> Tf Tompor.11-y (In.,wre <br /> {It (II"r1".y flf'llr f. Ifl'.411 ' <br />