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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 /> PORT OF STOCKTON PORT PORTO22 <br /> 22 <br /> S O. OF STOCKTON <br /> 2089 '2201 WEST 'WASHINGTON STREET <br /> STOCKTON, <br /> N, CA 95201 STOCKTON, CA 95203 <br /> Billing statement for —_ 1987 _ _ Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 Due JUNE 1 , 1987 <br /> Facility $ 100.00 -- <br /> Container # *Status Container # *Status <br /> 1 A $50.00 �7 A- —50. 0 <br /> _2 A 50.00 � x.-40 <br /> 3 A :59.00 <br /> v A 50, )7 -- PAYMENT <br /> 5 A 50.0 RECEIVED <br /> 6 A 50.00 JUN 10 <br /> State surcharges @ $56 per tank x = .ENVIRC]NMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Subtotal of permit fees : $500.00 <br /> Additional Billings or credits Credit from 1986 $ 24.00 <br /> overpayment <br /> TOTAL FEES DUE: $ 476.00 <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 "fled 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. Bow 2009. Stockton. CA 95201 <br /> A - AC[Ive <br /> IC - Temporary CIOsule <br /> PC - Permanent Cloture <br /> 0 40 <br />