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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 /> -LAURA46 <br /> LAURA SCUDDERS -LAURA SCUDDERS <br /> 4640 WATERLOO RD. •4640 WATERLOO RD. <br /> STOCKTON, CA 95205 •STOCKTON, CA 95205 <br /> Billing statement for 1987 PERMIT , Underground Tank Facility. <br /> Statement Date: JULY 21, 1987 l / P( / <br /> Due: AUGUST 21, 1987 <br /> Facility g 100.00 <br /> Container N *Status _� �• <br /> 1 A $ 50.00 / / v <br /> $ a <br /> State surcharges @ $56 per tank x _ _ $ <br /> Subtotal of permit fees: $ 150.0 <br /> Additional Billings or Credits <br /> (DEBIT BALANCE DUE-1986) $ 26.00 <br /> (A-tank & SC $ 176.00 <br /> TOTAL FEES DUE: <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 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 /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />