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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 /> AMERICAN FOREST PRODUCTS CO. <br /> P. 0. BOX 8368 AMERI01 <br /> STOCKTON, CA 95208 -AMERICAN FOREST PRODUCTS <br /> • 1800 MARSHALL <br /> -STOCKTON, CA 95205 <br /> Billing statement for _ 1987 _ _ , Underground Tank Facility- <br /> Statement Date: OCTOBER 21, 1987 Due OCTOBER 31, 1987 <br /> Facility S---LOO.00 <br /> Container N *Status Container # *Status <br /> PAYMENT <br /> PC 5 90 7 PC $90 RECELVED <br /> 3 A Q F�_ 90 F x <br /> -4- � �- -- -- E. <br /> W_ <br /> 9 E <br /> PC .ENVIRONMENTAL HEALTH <br /> —6 -EXEMPT �— PERMIT/SERVICES <br /> State surcharges @ $56 per tank x = $ <br /> Subtotal of permit fees : $ 610.00 <br /> Additional Billings or credits Fees due 19_86 -DEBIT $_48.00 <br /> Fees Paid 1987-CREDIT -$ 286.00 <br /> TOTAL FEES DUE: $372.00 <br /> Proal Ues viii tx added Notify the San Joaquin local Health 01strict <br /> past due date as sho..nof any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> 30 days - IOOI of Best Fee and approval of facility. <br /> Return payment along with one copy of this <br /> statement to: <br /> San Joaquin local Health District <br /> • (nvironmental Health Permil/Services <br /> A - Active P. 0. Bo. 1009. Stockton, CA 95701 <br /> 1C - Temporary Closure <br /> PC - Pe rsna nenl Closure <br />