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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 /> PETER42 <br /> TED PETERS TRUCKING COMPANY, INC. TED PETERS TRUCKING COMPANY , INC. <br /> P.O. BOX 831 4201 EAST HWY 120 <br /> MANTECA, CA 95336 _ MANTECA, CA 95336 <br /> Billing statement for 1987 Permit , Underground Tank Facility. <br /> Statement Date: MAY 1 1987 <br /> Due: JUNE 1 , 1987 <br /> Facility $ 100.00 <br /> Container M *Status <br /> A X5000 <br /> �— ppYNtiT <br /> Ft�GFIVE� 1P <br /> JO no <br /> State surcharges @ $56 per tank x = � NV1���yMENTA"� HEALTH <br /> PERMIT SERVICES <br /> Subtotal of permit fees: $150.00 <br /> Additional Billings or Credits <br /> Additional fee for 1986 $ 26.00 <br /> (Balance from 1986) !-- 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 /> P. 0. Box 2009, Stockton , CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Perm,)rwnt Closure <br />