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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 />.THE SOUTHLAND CORPORATION <br /> <br /> <br />Billing statement for <br />Statement Date <br />Due: <br />Facility <br />Container # <br />2 <br />3 <br />SEVEN27 <br />7 -ELEVEN FOOD STORE 2243-14117 <br />• 2725 COUNTRY CLUB BLVD. <br />STOCKTON, CA 95204 <br />1987 PERMIT , Underground Tank Facility. <br />MARCH 1, 1987 <br />MARCH 31, 1987 <br />Status <br />A <br />A <br />State surcharges @ $56 per tank x <br />Subtotal of permit fees: <br />Additional Billings or Credits <br />Penalties will be added <br />after due date as shown: <br />30 days - 100% of Base Fee <br />50 <br />50 <br />TOTAL FEES DUE: <br />PAYMENT <br />RECEIVED <br />N1 AY 4 lybI <br />$ 250 ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />$ 250.00 <br />Notify the San Joaquin Local Health District <br />of any corrections or changes necessary. <br />Permit will be mailed upon receipt of payment <br />and approval of facility. <br />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 />C <br />