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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 /> 'WALLY20 <br /> 'VAN & BOB' S INC . 'WALLY' S CHEVRON <br /> 2088 MARIPOSA RD. ' 2088 MARIPOSA RD . <br /> STOCKTON, CA 95205 ' STOCKTON , CA 95205 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: Aiarch 15, 1987 <br /> Due: April 15, 1987 <br /> Facility 100 <br /> Container # *Status <br /> 1 A 150 , <br /> 2 A 55`7 <br /> 3 A 50 <br /> - 4 A <br /> 5 A $50_ <br /> -- PAYMENT <br /> RECEIVED <br /> State surcharges @ $56 per tank x _ S , �� APR 16 1981 <br /> Subtotal of permit fees: $ fNV1RONMENTAL HEALTH <br /> Additional Billings or Credits PERMIT/SERVICES <br /> $350.00 <br /> TOTAL FEES DUE: $350.00 <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 /> Environmental Health Permit/Services <br /> A Active <br /> P. 0. Box 2009, Stockton, CA 95201 <br /> - <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />