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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 /> Jogi Khanna, M.D. , Health Officer <br /> sel [ � '- <br /> hrP 't7 <br /> HOLTP40 <br /> 'Pake It / �`fia+' 3° PARKER HOLT <br /> 40 0 Pla ner ei is <br /> St ck A 5 09 9 '� q� v°9 4000 WAGNER HEIGHTS RD. <br /> -e"O STOCKTON, CA 9520 <br /> 04 <br /> Billing w . <br /> statement for <br /> 1987 Permit , Underground Tank Facility, <br /> Statement Date: JULY 21, 1987 -st . ��seph-c u <br /> Due: AUGUST 21, 1987 C a r p i C o K / <br /> �f & 7- &5k� <br /> Facility wII xa� '^-y, 'do.� <br /> $ 100.00 rr. V <br /> Container y `SAatus 50.00' ra�CO <br /> 1 ` <br /> �- A 0 <br /> AUG <br /> $-- ENVIROMENTAL HEALTH <br /> $ PERMIT/SERVICES <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 200.00 <br /> Additional Billings or Credits <br /> Debit Balance Forward-1986 106.00 <br /> (Additional tank & Surcharge $ <br /> TOTAL FEES DUE: $ 306.00 <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 P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />