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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6181 <br /> Jogi Khanna, M.O. , Health Officer <br /> GOLDB80 <br /> .GOLD BOND GOLD BOND <br /> 800 W. CHURCH STREET 800 W. CHURCH STREET <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 <br /> Billing statement for 1981 Permit Underground Tank facility. <br /> Statement Date: JUNE 3. 1987 <br /> Due: JUNE 30, 1987 <br /> Facility S 100.00 <br /> Container N Status <br /> _] A 5 50.00 <br /> 2 A $ 50.00 <br /> 3 A 50.00 <br /> State surcharges @ SS6 per tank x = S <br /> Subtotal of permit fees : S 250.00 (� , <br /> Additional Billings or Credits v / <br /> -TOTAL FEES DUE: S 250.00 <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 - 1001 of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local health District <br /> Environmental health Perini t/Services <br /> P. 0. Box 2009. Stockton, CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> I'f - Perwanent Closurt. <br />