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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Boz 2009 <br /> Stockton, CA 95201 <br /> '(209).-466-6781 <br /> i <br /> Jogi Khanna, M.D. , Health Officer <br /> �I3i1�...� ���rss5 �= �•, <br /> ESCALON BE OE c ;,J r-f Fv��� �u �- ESC 13 <br /> 1305 LOfy AVENUE ESCALON BEACON <br /> E 0N, CA, 95320 1337 3���� C, 9!r „ 1.305 ESCALON AVENUE <br /> Ex�do�, c,+ � ���c ESCALON, CA 95320 <br /> Billing statement for 1987 P�t <br /> Underground Tank Facility. <br /> Statement Date: APRIL 1, 1987 <br /> Due: MAY I, 1987 <br /> L <br /> Facility $ 100 <br /> Container # Status <br /> 1 A50 <br /> �-- �- 50 <br /> 50 <br /> State surcharges @ $56" per tank x <br /> Subtotal of permit fees: ; $250.00 <br /> F <br /> Additional . Billings or Credits <br /> TOTAL FEES DUE: $ 250.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after- due date as shown: of 'any corrections'jor changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> and approval of facility. <br /> 30 days - 100% of Base Fee I <br /> v Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District r <br /> Environmental Health Permit/Services i <br /> * P. 0. Box 2009, Stockton, CA 95201 t <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure :3 <br /> 4 <br />