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L <br /> 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 /> ' BREUN76 <br /> • <br /> <br /> STOCKTON, CA 95207 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: !larch 15, 1987 <br /> Due: April 15, .1987 <br /> Facility $ 100 <br /> Container # *Status <br /> 1 A .$50 _ <br /> $ PAYMENT <br /> $ REGEIVED <br /> State surcharges@ $56 per tank x — _ �_ . E MAY 4 1981 <br /> Subtotal of permit fees: $ 150 ENVIRONMENTAL HEAt_TH <br /> PERMIT{SERVICES <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: $ 150.00 <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 /> * P. 0. Box 2009, Stockton, CA 95201 <br /> A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />