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14 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-5781 <br /> Jogi Khanna, M.D. , Health Officer <br /> . PIENA20 <br /> 'PIE NATIONWIDE, INC. . PIE NATIONWIDE, INC. <br /> 2007 N. WILSON WAY . 2007 N. WILSON WAY <br /> STOCKTON, CA 95205 . STOCKTON, CA 95205 <br /> Billing statement for 1987 Per Underground Tank Facility. <br /> Statement Date: March 15, 1987 <br /> Due: A ril 15, 1987 r <br /> Facility $ 100.00 <br /> Container # *Status <br /> 1 A 50.00 <br /> $ __, PAYMENT <br /> -- $�: RECEIVED <br /> .� APR is 1987 s <br /> -- � ENVIRONMENTAL HEALTH <br /> State surcharges @.$56 per tank x = -PERMIT/SERVICES <br /> Subtotal of permit fees: $ 150.00 ' <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $ 150.00 <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 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. O. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />