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r <br /> 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 /> i4OODBRIDGE VINEYARD ASSOCIATION WOODB46 <br /> WOODBRIDGE VINEYARD ASSOCIATION <br /> LODI W. TURNER RD. .4614 W. TURNER RD. <br /> ODI , CA 95240 .LODI , CA 95240 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: March 15, 1987 <br /> Due: April 15 1987 <br /> Facility $ 100.00 PAYMENT <br /> RECEivtr� <br /> Container M *Status 4s <br /> -1_ A 50 00 A U fi <br /> 0—VIRONti <br /> PERiv.1, HEALTH <br /> ". CES <br /> State surcharges @ $56 per tank x = <br /> Subtotal of permit fees: J D <br /> Additional Billings or Credits <br /> 3 <br /> TOTAL FEES DUE: $ 20"0 a b <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 /> 30 days - 100% of Base Fee and approval of facility. <br /> 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 P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />