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4' <br /> 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 /> SANBO12 <br /> SANB1210 SCHEROKEE LANE N CHEVROLET INC. ' SAN BORN CHEVROLET <br /> 1210 S CHEROKEE LANE <br /> LODI S DI , CA 95240 LODI , CA 95240 <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 /> 1 A5E 0 <br /> 2 �— PAYMENT <br /> S_ REGEIV kTD <br /> �- MAY 4 1981 <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> State surcharges @ S56 per tank x <br /> Subtotal of permit fees: 5200 <br /> Additional Billings or Credits <br /> S <br /> TOTAL FEES DUE: 5 200 .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 - 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 <br /> P. 0. Box 2009. Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />