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40 <br /> cjAN JOAOUIrI LOCA1 HEALTH DISTRICT <br /> 1601 E . Ilazel ton Avi, . , P . 0. BOX 2009 <br /> Stockton, Ca 95201 <br /> (209) 466-6781 <br /> Jogi Khanna , M.D. , Health Officer <br /> T0PFI10 <br /> ENDICH BROS . TOP FILLING STATION <br /> 101 S . WILSON 'WAY 101 S . WILSON WAY <br /> STOCKTON , CA 95205 STOCKTON , CA 95205 <br /> Billing statement for _1987 Permit Underground Tank Fac i 1 i ty. <br /> Statement Date : May 1 , 1987 Due June 1 , 1987 <br /> Faci 1 i ty S100._ �_ <br /> Container *Status Container *Status <br /> 1 A $50 _ 5 <br /> 2 A 5 0 �. <br /> 3 _ A 50 Y <br /> 4 PC 90 <br /> —— —1?-AcY M E N T <br /> — — — —~ —R-lE£E II V E D <br /> MAY 4 1'-)�8l <br /> State surcharges @ $56 per tank x $ .ENVIRONMENTAL HEALTH <br /> Subtotal of permit fees : $_ 34Il <br /> PERMIT SERVICES <br /> Additional Billings or credits <br /> TOTAL FEES DUE : $340 . 00 <br /> Penalties will be added Notify the San Joaquin Local Health Oistrict <br /> Past due date as shown: of any corrections or chances necessary. <br /> Permit will be +nailed upon receipt of payment <br /> and approval of facility. <br /> 30 days - 1001 of Base fee Return payment along w+ th one copy of this <br /> statement to. <br /> San Joaquin Local Health Otstrict <br /> Cnvironmental Health Permit/Services <br /> A Active P. 0. Box 7007, Stockton. CA 952D1 <br /> T( - Temporary Closure <br /> PC - Permanent Closure <br />