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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 /> BILL RACKLEY TRUCKING, INC. RACKL33 <br /> 3333 S HWY 99 BILL RACKLEY TRUCKING <br /> STOCKTON, CA 95206 3333 S. HIdY 99 <br /> STOCKTON, CA 95206 <br /> Billing statement for 1987 Underground Tank Facility. <br /> Statement Date: DECEMBER 1, 1987 DUe DECEMBER 30, 1987 <br /> Facility $ 100.00 <br /> Container # *Status Container # *Status <br /> 1 A $ 50 $ <br /> 2 A 50 <br /> State surcharges @ $56 per tank x - $ <br /> Subtotal of permit fees : $ 200.00 <br /> Additional Billings or credits $ <br /> TOTAL FEES DUE: $ 200.00 <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 PAYMENT <br /> Environmental Health Permit/Services RECEIVED <br /> A Active P. 0. Boa 2009. Stockton. CA 95201 <br /> TC - Temporary Closure ��� r! 1 <br /> PC - Permanent Closure <br /> ENVIRONMENTAL HEALTH <br /> PERMIT f SERVICES <br />