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'.P,;; JO,1QUII'l tll(JO IILA1.111 I)l1,1RICI <br /> ll,wr 1 ton Avu . , P , 0. BOX 2009 <br /> kc k toll I <br /> (209) 400-6181 <br /> Jogi Khanna , M.1). heal th Officer <br /> JERRY NOMA PLANT OPERATION <br /> NORTHERN ChLIF YOUTH CENTER COMPLEX NORTH76 <br /> P.O. BOX 213004 NORTHERN CALIF YOUTH CENTER COMPLEX <br /> STOCKTON, CA 952139004 ATTN: JERRY NOMA, PLANT OPERATION <br /> 7650 S. NEWCASTLE ROAD <br /> STOCKTON, CA 952139004 <br /> (filling statement for e1 7 pERRU_ , Underground Tank Facility. <br /> Statement Date :----MAY-1.-12B7— DLAe_ ,hjNf 1 , 1 gf37 _ <br /> Faci 1 i ty S __100-1Q-0 <br /> Container "Status Container d *Status <br /> 1 A S 50.00 S_SQ�.IlO <br /> -2— —A -5n-m <br /> 3 A -S(L O _ <br /> —`— —A 50.00 <br /> -5 � — <br /> - A -50-OD PAYMENT <br /> �- ,A -LDD _ _ —RECEIVEDip, <br /> 7 _A o — <br /> MAY 19 <br /> State surcharges @ $56 per tank x = 5 ENVIRONMENTAL HEA LT14 <br /> PERMPT f SERVICES <br /> SubtotaT`ef permit fees : S 500.00 <br /> Additional Billings or credits S 106.00 <br /> Credit from 1986 TOTAL FEES DUE : $ 394.00 <br /> Penalties will be added Notify the San Joaquin local ltealth Dlstriet <br /> past due date as shown: of any (orre(tIons or changes necessary. <br /> Permit will be rnailed upon receipt of payment <br /> and approval of fa(Itity <br /> JO days - 1001 of Ilntr fee <br /> Return payment along with one copy of this <br /> tt41,•rv'nl to <br /> San Joarlu,n Io(al Ilralth District <br /> • Invironmrnt#I Ile alth Permit/Service% <br /> A A(t t r ?{Ing, `,(uts lun. CA 9;701 <br /> IC Irngrprary tln5,nr <br /> Int Pr rrna nrni ( In1„rr <br />