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� (7 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> �" 1601 E. Hazelton Ave. , P. 0. Box 2009 UN G 198 <br /> Stockton, CA 95201 <br /> {209) 466-6781 ENVIROME <br /> NTAL HEALTH <br /> F ERN1iT/SERV1C£S <br /> Jogi Khanna, M.D. , Health Officer <br /> - OKAMO14 <br /> ` SAN JOAQUIN COUNT"Y • 145 S. SUTTER ST. <br /> 222 E. WEBER AVE • STOCKTON, CA 95206 <br /> STOCKTON, CA 95202 <br /> Billing statement for 1987I Permit Underground Tank Facility. <br /> Statement Date: MAY 20, 1987 <br /> Due: JUNE 20, 1987 <br /> Facility $ 100.00 <br /> Container # *Status <br /> 2 -A <br /> 1 _ —L S 50.00 <br /> 4 A 50._00 () I y i I - <br /> 1 <br /> State surcharges @' $56 per tank x <br /> Subtotal of permit fees: $300.00 <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: 300.00 <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 <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 />