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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95''201 <br /> (209) 468-3425 <br /> Jogi Khanna, M.D. , Health Officer <br /> MANDK89 <br /> DOUG MANSER M AY <br /> 2960 W. WALNUT GROVE ROAD 8960 W. WALNUT GROVE ROAD <br /> THORNTON„ CA 5625 THORNTON„ CA 95625 <br /> Billing Statement For 1922 Permit., Underground Tank Facility , <br /> Statement Date : January iS, 10 <br /> Payment Due Date; February 15; 08:'1' <br /> Facility Fee: 100.00 <br /> Container Number ; 0001 50.00 <br /> 0001 50.00 <br /> 0003 50.00 <br /> TOTAL FEES DUE --8250.00 <br /> NOTES; <br /> Notify the San Joaquin Local <br /> Health District of any <br /> corrections or Changes <br /> necessary . Your permit will <br /> be mailed upon receipt of <br /> payment and approval of <br /> facility. <br /> Return payment along with one <br /> copy of this statement to: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT18ERVICES <br /> P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> Penalties will be added after <br /> due date as shown; <br /> 30 days - 100% of Base Fee <br />