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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 /> • MATHEIO <br /> R. B. MATHESON HOLDINGS MATHESON FAST FREIGHT <br /> <br /> LODI , CA 95240 <br /> Billing statement for 1987 PERMIT Underground Tank Facility. <br /> Statement Date: APRIL 15, 1987 <br /> Due: MAY 15, 1987 <br /> Facility $ 100.00 <br /> Container N Status <br /> —1_ - $_ 90-n <br /> —2_ $ �n_nn <br /> $ PAYMENT <br /> $ RECEIVED <br /> - $ MAY 1 1987 <br /> State surcharges @ $56 per tank x = $ <br /> ENVIRONMENTAL HEALTH <br /> Subtotal of permit fees: $200.00 PERMIT/SERVICES <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $200.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after 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 />