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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 /> FRANK40 <br /> FRANK'S EXXON #3 FRANK'S EXXON #3 <br /> 4022 HIGHWAY 120 4022 HIGHWAY 120 <br /> MANTECA, CA 95336 MANTECA, CA 095336 <br /> Billing statement for ___1987 PERMIT _ _ Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 Due JUNE 1. 1987 <br /> Facility $ 100.00 <br /> Container # *Status Container # *Status <br /> _ 1 A S 50.00 7 A S 50.00 <br /> 2 A 50.00 8 A 50.00 <br /> _3 A —50.00 9A 50.00 <br /> A -5M.00 10 __V X0.00 <br /> _5 -A— 50.00 <br /> 6- _V_ �-00 <br /> State surcharges @ $56 per tank x = $ <br /> Subtotal of permit fees: S 600.00 <br /> Additional Billings or credits -Additional fee from 1986 S 32.00 <br /> or unuerpayment <br /> TOTAL FEES-DUE: $632.00 <br /> Penalties will be added Notify the San Joaquin local Health District <br /> past 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 />