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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 /> • GEORG16 <br /> GEORGE TERANISHI • GEORGE'S SERVICE <br /> 1600 W. DURHAM FERRY RD. • 1600 W. DURHAM FERRY RD. <br /> TRACY, CA 95376 • TRACY, CA 95376 <br /> Billing statement for 1987 PERMIT , Underground Tank Facility. <br /> Statement Date: APRIL 15, 1987 <br /> Due: MAY 15, 1987 <br /> Facility $100 <br /> Container 8 *Status s <br /> 2 A- '—tu <br /> _� <br /> 50 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 300.00 <br /> Additional Billings or Credits `0Cg/�s� <br /> $ <br /> TOTAL FEES DUE: $ 300.00 <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 />