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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 />UNION27 <br />.UNOCAL UNION OIL SS#5886 <br />2175 N CALIFORNIA BLVD. STE. 650 .2701 W MARCH LANE <br />WALNUT CREEK, CA 94596 STOCKTON, CA 95207 <br />Billing statement for 1987 Permit , Underground Tank Facility. <br />Statement Date: March 15, 1987 <br />Due: April 15 ,..1987 <br />Facility 1 100 <br />Container # *Status <br />1 A $ 50- <br />2 A 50 <br />3 A50 <br />State surcharges @ $56 per tank x _ =_ <br />Subtotal of permit fees: $250 <br />Additional Billings or Credits <br />$ X <br />TOTAL FEES DUE: $ 250.00 1 %-, <br />Penalties will be added <br />after due date as shown: <br />30 days - 100% of Base Fee <br />A - Active <br />TC - Temporary Closure <br />PC - Permanent Closure <br />n <br />Notify the San Joaquin Local Health District <br />of any corrections or changes necessary. <br />Permit will be mailed upon receipt of payment <br />and approval of facility. <br />Return payment along with one copy of this <br />statement to: <br />San Joaquin Local Health District <br />Environmental Health Permit/Services <br />P. 0. Box 2009, Stockton, CA 95201 <br />;j <br />