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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 /> COUNTRY NISSAN • COUNT15 <br /> 1515 N. MAIN STREET • COUNTRY NISSAN <br /> MANTECA, CA 95336 . 1515 N. MAIN STREET <br /> . MANTECA, CA 95336 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: -JANE 24 1987 <br /> Due: JULY 15, 1987 <br /> Facility $ 100 <br /> Container N "Status <br /> 1 50.00 <br /> —Z A 50.00 PAYMENT <br /> RECEIVED <br /> JUS :; 1987-7r <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Subtotal of permit fees: $ 200.00 <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: $ 200.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after 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 /> t Environmental Health Permit/Services <br /> A - Active P. 0. Dox 2009, Stockton, Cb 9`)201 <br /> TL - Temporary Cla ,un <br /> I'r. Permanent Clo .ur <br />