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4 <br /> Y <br /> SA*JOAQUIN LOCAL HEALTH OISTRICT <br /> 1601 E. Hazelton Ave. . P. 0. Boz 2009 <br /> Stockton. CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna. M.O. . Health Officer <br /> .GOLD BOND GOLDB80GOLD BOND <br /> 800 W. CHURCHSTREET 800 W. CHURCH STREET <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: JUNE 3. 1987 <br /> Due : JUNE 30, 1987 <br /> Facility S 100.00 <br /> Container M Status <br /> _1 A S 50.00 <br /> A 50 00 <br /> _3 A 50 JQO <br /> State surcharges @ 156 per tank x _ = S <br /> Subtotal of permit fees: S 250.00 <br /> Additional Billings or Credits <br /> -TOTAL FEES DUE: S 250.00 <br /> Penalties will be added Notify the San Joaquin Local health Oistrict <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 cony of this <br /> Statement to: <br /> San Joaquin Local Health District <br /> Environmental Health Perini t/Services <br /> A - Active P. O. Box 2009. Stockton. CA 95201 <br /> TC - Temporary Closure <br /> Pf - Prr'm.1nw�I Closure• <br />