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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 />TRACY COMMUNITY MEMORIAL HOSPITAL <br />1420 N. TRACY BLVD. <br />TRACY, CA 95376 <br />* TRACY14 <br />* TRACY COMMUNITY MEMORIAL HOSPITAL <br />* 1420 N. TRACY BLVD. <br />* TRACY, CA 95376 <br />Billing statement for _j287 Permit , Underground Tank Facility. <br />Statement Date: ARRI-1-35. 1987 <br />Due: MAY 15, 1987 <br />Facility $ 100.00 <br />Container # Status <br />--1A $ 50.00 <br />2 -A $ 50.00 <br />3 A 50 -no <br />State surcharges @*$56 per tank x <br />Subtotal of permit fees: <br />Additional Billings or Credits <br />Penalties will be added <br />past due date as shown: <br />13 <br />30 days - 100% of Base Fee <br />A - Active <br />TC - Temporary Closure <br />PC - Permanent Closure <br />$250.00 <br />TOTAL FEES DUE: $ 250.00 <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 />0 <br />