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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 /> CAINS23 <br /> CAIN'S ELECTRIC WORKS CAIN'S ELECTRIC WORKS <br /> 230 N. CHURCH STREET 230 N. CHURCH STREET <br /> LODI , CA 95240 LODI , CA 95240 <br /> Billing statement for 1987 Permit Underground Tank Facility_ <br /> „statement Date: jUNF 1. 1g87 <br /> Due: JULY 1 , 1987 <br /> Facility S 100.00 Recti EIyJ <br /> Container N Status <br /> �_ S sn nn JUN 2 = ;. <br /> �— ZNVIR p 7� <br /> �— PERM/l uq/`fa'. t <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 150.00 <br /> Additional Billings or Credits <br /> Balance from 1986 SI15.00 <br /> TOTAL FEES DUE: S-266.00 <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 /> P. 0. Box 2009, Stockton, CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Clo%ury <br />