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• i <br /> PAYMENT <br /> RECEIVED <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT X1987 <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 O C T <br /> Stockton, CA 95201 ENVIRONMENTAL HEALTH <br /> (209) 466-6781 PERMIT ISERVICES <br /> Jogi Khanna, M.D. , Health Officer <br /> PACIF32 <br /> • PACIFIC COAST PRODUCERS PACIFIC COAST PRODUCERS <br /> P. 0 . BOX 880 - 32 TOKAY ST. <br /> Lodi , CA 95240 LODI , CA 95240 <br /> Billing statement for 1987 Permit , Underground Tank Facility. <br /> Statement Date: SEPTEMBER 3, 1987 <br /> Due: OCTOBER 3, 1987 <br /> Facility $ <br /> Container # *Status <br /> State surcharges @ $56 per tank x 1 = 56 -(New Tank) <br /> Subtotal of permit fees: $ 56.00 <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $ 56'00 <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 /> A Active <br /> P. 0. Sox 2009, Stockton, CA 95201 <br /> - <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />