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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.O. . Health Officer <br /> SKIPS SERVICE STATION * SKIPS30 <br /> 300 S . CALIFORNIA ' SKIPS SERVICE STATION <br /> STOCKTON, CA 95206 ' 300 S . CALIFORNIA <br /> STOCKTON, CA 95206 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: MAY 1 , 1987 <br /> Due: JUNE 1, 1987 <br /> Facility 5 100.00 <br /> Container N Status <br /> 1 A5E 0 <br /> 2 _� 5- <br /> 14 S59 <br /> 4 _ A $50 PAYMENT <br /> 5 A 50 RECEIVED <br /> $ JUN 4 1987 <br /> State surcharges @ $56 per tank x _ _ �_ ENVIRONMENTAL HEALTH <br /> Subtotal of permit fees: 5350 PERMIT/SERVICES <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: 5350 .09 <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 P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> 4 .� <br />