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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 /> CIRCLE K CORPORATION . CIRCL20. CIRCLE K #1334 <br /> 2650 .�IT. DI ABLO ST . . 2650 MT. DI ABLO ST . <br /> STOCKTON, CA 95203 . STOCKTON, CA 95203 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: March 15 L987 <br /> Due: April 15 ]..987 <br /> Facility $ 100 <br /> Container # *Status <br /> I. A $ 50 <br /> 2 A 50 <br /> 3 A 50 <br /> $ PAYMENT <br /> RECEIVED <br /> State surcharges @ $56 per tank x - APR 198 <br /> Subtotal of permit fees: $250 INVIRQNMENTAL HEALTH <br /> Additional Billings or Credits PERMIT/SERVICES <br /> TOTAL FEES DUE: $ 25`3.00 <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 /> A Active <br /> P. 0. Box 2009, Stockton, CA 95201 <br /> - <br /> TC - Temporary Closure <br /> PC _ Permanent Closure <br />