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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 /> 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 S 100.00 <br /> Container # *Status Container # *Status <br /> _ 1 A $ 50.00 7 A S50.00 "J <br /> 2 A _J0-00 8 A 50.00 <br /> A _5D-00 9 _A 50.00 <br /> -500 10 0.00 <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 /> for underpayment - — <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 - 1001 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. Bo. 2009. Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />