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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 1, I1�11 <br /> Stockton, CA 95201 <br /> (209) 466-6781TVA <br /> A1JG �' ig8� <br /> Jogi Khanna, M.D. , Health Officer aEN�1E M1T%SERVIEAl- <br /> Ces <br /> •SANJ055 <br /> SAN JOAQUIN COUNTY MOSQUITO -SAN JOAQUIN CO MOSQUITO ABATEMENT DIST. <br /> <br /> <br /> <br /> Billing statement for Igg7 Underground Tank Facility. <br /> Statement Date: JULY 21, 1987 <br /> Due: --MUST 21, 1987 <br /> Facility $ <br /> Container N *Status <br /> State surcharges @ $56 per tank x _ _ �— <br /> Subtotal of permit fees: $ <br /> Additional Billings or Credits <br /> Rack feat due- 1986 $ 32.00 <br /> TOTAL FEES DUE: E 32.00 <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 />