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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.D. , Health Officer <br /> sIAI?S40 <br /> . ROSATO AND RELF INVESTMENTS J.H. SIMPSON COMPANY <br /> P. O. BOX 8640 4025 CORONADO AVE <br /> STOCKTON, CA 95208 STOCKTON, CA 95294 <br /> Billing statement for 1987 Permit Underground Tank Facility, <br /> Statement Date: MAY 1 , 1987 <br /> Due: JUNE 1 , 1987 <br /> Facility $ 100.00 <br /> Container M •Status <br /> �— A 1,50 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $150 <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $ 150 .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 P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> N- . .-� <br />