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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 />. TRACY14 <br />TRACY COMMUNITY MEMORIAL HOSPITAL . TRACY COMMUNITY MEMORIAL HOSPITAL <br />1420 N. TRACY BLVD. . 1420 N. TRACY BLVD. <br />TRACY, CA 95376 . TRACY, CA 95376 <br />Billing statement for 1987 Permit Underground Tank Facility. <br />Statement Date: ARgjI 398� 7 <br />Due: MAY 15, 1987 <br />Facility 100.00 <br />Container # Status <br />-2---. A 50.00 <br />� A 50.00 <br />0 <br />PAYMENT <br />RECEIVED <br />State surcharges @'$56 per tank x _ = MAY 13 1987 <br />Subtotal of permit fees: $ 250.00 ENVIRONMENTALRHEALTH <br />Additional Billings or Credits 17/SERVICES <br />$ <br />TOTAL FEES DUE: $ 250.00 <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 - 1005 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. Box 2009, Stockton, CA 95201 <br />TC - Temporary Closure <br />PC - Permanent Closure <br />