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Nape <br /> .r <br /> 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 $ 100.00 <br /> Container # *Status Container N *Status <br /> P�— $ 907 50 78 PC $ 90 <br /> _ <br /> 3 A __50_— _— 90 <br /> —4— A W — <br /> 5 PC 90 _ <br /> _6 -EXEMPT _T— — <br /> State surcharges @ $56 per tank x = $ <br /> Subtotal of permit fees : $ 610.00 <br /> Additional Billings or credits Fees due 1986 -DEBIT $ 48.00 <br /> Fees Paid 1987-CREDIT -$ 286.00 <br /> TOTAL FEES DUE: $372.00 <br /> 'Penalties will to added Notify the San Joaquin Local Health District <br /> past due date as shown: of any corrections or changes necessary. <br /> Permit will he 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 P. 0. 80. 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> `r <br />