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1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Ila zelton Ave. , P. O. BOX 2009 <br /> Stockton, Ca 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> PORT022 <br /> DORT OF STOCKTON 'PORT OF STOCKTON <br /> P.(1.90X 2089 '2201 WEST 'WASHINGTON STREET <br /> STOCKTON, CA 95201 "STOCKTON, CA 95203 <br /> Billing statement for �_I987 �__ Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 Due JUNE 1 , 1987 <br /> Facility L0O.00_ <br /> Container # *Status Container # *Status PAYMENT <br /> RECEIVED <br /> 1 A 550.00 7 $-5nj0 b <br /> --2 A SO.00 � 3 _� -�� JUN 4 1987 <br /> 3 A 57,09 <br /> A 50. �7 )ENVIRONMENTAL HEALTH <br /> - A 50,90 PERMIT/SERVICES <br /> 6 A 50.0,0 <br /> State surcharges @ $56 per tank x - $ <br /> Subtotal of permit fees : $500.00 <br /> Additional Billings or credits Credit from 1986 $ 24.00 <br /> overpayment TOTAL FEES DUE : $ 476.00 <br /> 'Penaltles will be added Notify the San Joaquin Local Health District <br /> pest due dote 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 - 1001: of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin local Health oistrict <br /> Environmental Health Permit/Services <br /> P, 0, Bo: 2009. Stockton. CA 95201 <br /> A - Active <br /> IC - Temporary Closure <br /> PC Permanent Closure <br /> 0 0 <br />