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1 . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 / <br /> (209) 466-6181 r <br /> Jogi Khanna, M.D. , Health Officer <br /> 'Parker Holt HOLTP40 <br /> 4000 Wagner Heights PARKER HOLT <br /> Stockton, CA 95209 4000 WAGNER HEIGHTS RD. <br /> STOCKTON, CA 95209 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: JULY 21, 1987 <br /> Due: AUGUST 21, 1987 <br /> Facility $ 100.00 <br /> Container # *Status <br /> 1 A 5�0.00 <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 8. Surcharge <br /> TQTAL FEES DUE: $ 306.00 <br /> Penalties will be added <br /> 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 />