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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 /> JACKSON BUICK - PONTIAC, INC. JACKS41JACKSON BUICK - PONTIAC, INC. <br /> P.O. BOX 1688 P.O. BOX 1688 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 <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 /> NT <br /> Container # "Status RECEIVED <br /> A 8 50.00 <br /> AUG 26 1987 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 150.00 <br /> AIditional Billings or Credits <br /> -_ _Credit for ] 86 <br /> -_90.00 <br /> TOTAL FEES DUE: S 60.00 <br /> Penalties%:will be added Notify the San Joaquin Local Health District <br /> pa °,t due &'te as shown: of any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> 30 days - 100% of Base Fee and approval of facility. <br /> Return payment along with one copy of thi , <br /> statement to: <br /> San Joaquin Local Health District <br /> Environmental Health Perinit/Services <br /> Active P. 0. Box 2009, Stockton , CA 95201 <br /> Temporary Closure <br /> Permanent Closure <br />