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0 i <br /> 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 /> • ERNIE44 <br /> . ERNIE' S GENERAL STORE • ERNIE'S GENERAL STORE <br /> 4407 E. WATERLOO RD. • 4407 E. WATERLOO RD. <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <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 A $ 50.00 <br /> A $ 50.00 <br /> A $ 50.00 <br /> PAYMENT <br /> �_— RECEIVED <br /> State surcharges @ $56 per tank x = $ MAY 4 1ydl <br /> Subtotal of permit fees: $250.00 .ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> Additional Billings or Credits <br /> S <br /> TOTAL FEES DUE: $250.00 <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 />