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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P.O. }boy; 2009 <br /> Stockton, CA 95201 <br /> (209) 468-342S <br /> Jogai Khanna, M:D. , Health Officer <br /> WORTLIS <br /> DONALD S. WOR'FLEY DONALD S. WORTLEY <br /> <br /> LORI, CA 95240 <br /> Billing Statement For 1989 Permit., Underground Tank Facility_ <br /> Statement Date August <br /> Payment Due Date: September 1 , 1989 <br /> Previous Balance 94.00- <br /> Facility Fee: 100.00 <br /> Container Number: 0001 SONO <br /> ---------- <br /> TOTAL FEES DUE 06.00 <br /> NOTES: <br /> Notify the San Joaquin Local <br /> Health District of any <br /> corrections or changes <br /> necessary . Your permit will <br /> be mailed upon receipt of <br /> payment and approval of <br /> facility. <br /> Return payment along with one <br /> copy of this stateftent. to; <br /> SAN JOArQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> F.O. BOX 2009 <br /> STOCKTON, CA 94201 <br /> Penalties will be added after <br /> due date as shown; <br /> 30 dais - 100% of Base Fee <br />