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SAN JOAOU1N LOCAL HEALTH DISTRICT <br /> 1601 E . ►►azel ton Ave. , P. 0. BOX 2009 <br /> Stockton, Ca 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> CHEVR92 <br /> CHEVRON U. S . A . INC . CHEVRON STATION #92396 <br /> 115 W . VINE 25650 N. HWY 99 <br /> LODI , CA 95240 ACAMPO, CA 95220 <br /> Billing statement for _J 987 per roti t Underground Tank Facility. <br /> Statement Date: May 1 , 1987 _ Due_ dungy <br /> Facility $100 <br /> Container *Status Container # *Status <br /> �2 A <br /> A <br /> --5- -A— 50 — <br /> State surcharges @ $56 per tank x = $ <br /> Subtotal of permit fees: $ _ <br /> Additional Billings or credits _aa1ajjS__due fr._Om $212 <br /> .....L9.8.6_(2_tAnks.-.&_-s ur_ch.arge ) TOTAL FEES DUE : $ 612 .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 /> JO days - IOOs of ease fee Return <br /> 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. Res ?009. Stockton. CA 95201 <br /> fC - Temporary Cio%urr <br /> i'C - t'ermenent Cioturr <br />