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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 />THREE PALMS GROCERY <br />6732 E. WATERLOO RD. <br />STOCKTON, CA 95205 <br />THREE67 <br />THREE PALMS GROCERY <br />6732 E. Waterloo Rd. <br />Stockton, CA 95205 <br />Billing statement for 1987 Permit , Underground Tank Facility. <br />Statement Date <br />Due: <br />facility <br />Container H <br />1 <br />September 1, 1987 <br />October 1, 1987 <br />`Status <br />TC <br />State surcharges @ $56 per tank x = <br />Subtotal of permit fees: <br />Additional Billings or Credits <br />Penalties will be added <br />past due date as shown <br />30 days - 100% of Base Fee <br />A - Active <br />TC - Temporary Closure <br />PC - Permanent Closure <br />S <br />g 30.00 - Balance Due for Temporary Closed Tank <br />TOTAL FEES DUE: <br />$ 30.00 <br />$ CD$ 30.00 <br />Notify the San Joaquin Local Health District <br />of any corrections or changes necessary. <br />Permit will be mailed upon receipt of payment <br />and approval of facility. <br />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 />I <br />