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9 0 <br /> 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 /> DAUSE23 <br /> BILL DAUSE BILL DAUSE <br /> P. O. BOX 423 , 23597 N HWY 99 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: March 15 , 1987 <br /> Due: April 15_1987 <br /> Facility $ 100 <br /> Container N *Status P AY M g N T <br /> 1 A 50 RgOgIVED <br /> 2 A 50 <br /> 3 A 50 M� W61 <br /> $ ENVIRONMENTAL HEALTH <br /> $ pERMITISERVICES <br /> State surcharges@ '$56 per tank x _ _ $ Wi <br /> Subtotal of permit fees: $250 <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: $ 250.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after 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 />