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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 /> • ERNIE25 <br /> .ERNIE ' S SEPTIC TANK CO. • ERNIE 'S SEPTIC TANK CO. <br /> P . 0. BOX 767 • 25409 N HWY 99 <br /> LODI , CA 95241 • 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 M *Status PAYMENT <br /> 3 A $ 50 RECEIVED <br /> 2 A 50 <br /> 3 A 50 MAY 4 IN7 <br /> �-- .ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> State surcharges @ $56 per tank x _ _ $ <br /> Subtotal of permit fees: $250 <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: <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 /> P. 0. Box 2009, Stockton, CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />