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SAID JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 456-5781 <br /> Jogi Khanna, M.D. , Health Officer <br /> • SHAUG6 0 <br /> J.C. SHAUGHNESSY • SHAUGHNESSY ' S CAR WASH <br /> 601 E MINER AVE . - 601 E MINER AVE. <br /> STOCKTON , CA 95202 • STOCKTON , CA 95202 <br /> Billing statement for 1987 Permit , Underground Tank Facility. <br /> Statement Date: March 15 1987 <br /> Due: Lril 15 1987 <br /> Facility $ 100 <br /> Container # *Status <br /> 1 A WSJ <br /> 2 A � <br /> 3 A 5fl <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $250 <br /> Additional Billings or Credits <br /> $ 250.90 <br /> TOTAL FEES DUE: <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 /> * P. 0. Box 2009, Stockton, CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />