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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 /> . ROTOR34 <br /> 'ROTO-ROOTER . ROTO-ROOTER <br /> P.O. BOX 5543 . 3480 EAST CARPENTER ROAD <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: _MAY 1 , 1987 <br /> Due: JUNE 1 , 1987 <br /> Facility S 100.00 <br /> Container N Status <br /> IA 0.00 <br /> $ 50.00 <br /> S PAYMENT <br /> RECEIVED _ <br /> �- JUN . . 1987 <br /> State surcharges @ S56 per tank x _ _ �— ENVIRONMENTAL HEALTH <br /> Subtotal of permit fees: PERMITJSERVICES <br /> _ 5200.00 <br /> Additional Billings or Credits <br /> —1386 fees (2 tank and '2surcharge and <br /> facility — S 312 .00 <br /> TOTAL FEES DUE : S 512 .00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> past due date as shoran: of any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> and approval of facility. <br /> 30 days - IOOx of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Ilealth District <br /> Environmental tied lth Perinit/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> R - Temporary C10turr• <br /> 1'r - 1'p ruu nvif 1, In`,urr• <br />