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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 /> J091 Khanna, M.D. , Health Officer <br /> XCLUS 11 <br /> ANGELICA HEALTHCARE SERVICES G KCLUSIVE LINEN SUPPLY <br /> 1145 S SIERRA NEVADA 1145 S SIERRA NEVADA <br /> STOCKTON, CA 95205 STOCKTON, CA 915205 <br /> Billing statement for 1287 Permit Underground Tank Facility. <br /> Statement Date: MAY 1 , 1987 <br /> Due: JUNE 1, 1987 <br /> Facility S 100.00 <br /> Container / }Status <br /> 1 A 50 <br /> 2 A �—��--- <br /> PAYMENT <br /> y RECEIVED <br /> MAY 21inn,�/k <br /> .ENVIRONMENTAL HEALTH <br /> State surcharges @ $56 per tank x = PERMIT/SERVICES <br /> Subtotal of permit fees: S 200 <br /> Additional Billings or Credits <br /> S <br /> TOTAL FEES DUE : - - S 290 . 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 - IOQX of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District <br /> • Environmental Health Perini t/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closurp <br />