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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 />. THREE PALMS GROCERY <br />. 6732 E. WATERLOO RD. <br />. STOCKTON, CA 95205 <br />Billing statement for 1987 PERMIT Underground Tank Facility. <br />Statement Date: JULY 21, 1987 <br />Due: AUGUST 21, 1987 <br />Facility $ 100.00 <br />Container N* <br />Status <br />A 50.00 <br />L 50.0N� <br />2 A 0 P�EGE J BO <br />_ $ ASG 2 � 19a1 <br />$_ �tyV1Rolt ISERV1CtH <br />P <br />State surcharges @ $56 per tank x 1_ = 56.00 <br />Subtotal of permit fees: $ 256.00 <br />Additional Billings or Credits <br />(CREDIT BALANCE 1986) A !X '-'�—Z o <br />- $ 16.00 <br />TOTAL FEES DUE: 5-249-00 <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. 0. Box 2009, Stockton, CA 95201 <br />TC - Temporary Closure <br />PC - Permanent Closure <br />