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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 /> •SANJO55 <br /> SAN JOAQUIN COUNTY MOSQUITO -SAN JOAQUIN CO MOSQUITO ABATEMENT C <br /> ABATEMENT DISTRICT •5503 S. AIRPORT WAY <br /> <br /> <br /> Billing statement for _]gR7 Underground Tank Facility. <br /> Statement Date: JULY 21, 1987 <br /> Due: JAUGUST 21 1987 <br /> Facility S <br /> Container N 'Status <br /> PAYMENT <br /> RgGEIVED <br /> AU G 2 01987 <br /> �— ENVIp��AIT�SERVICES HEALTH <br /> State surcharges @ ;56 per tank x _ _ <br /> Subtotal of permit fees: $ <br /> Additional Billings or Credits <br /> Rack fPPc di - 1986 $ 32.00 <br /> TOTAL FEES DUE: $ 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 /> 30 days - 100% of Base Fee and approval of facility. <br /> Return payment along with one copy of this <br /> statement to: I <br /> San Joaquin Local Health District <br /> t Environmental Health Permit/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />