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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 />FRANK13 <br />FRANK'S EXXON FRANK'S EXXON <br /> <br /> MANTECA, CA 95336 <br />Billing statement for 1987 Permit Underground Tank Facility. <br />Statement Date: March 15, 1987 <br />Due: April 15, 1987 <br />Facility <br />Container # *Status <br />_1 A <br />_2 A <br />_3 A <br />4 A <br />State surcharges @ $56 per tank x = <br />Subtotal of permit fees: <br />Additional Billings or Credits <br />Penalties will be added <br />past due date as shown: <br />30 days - 100% of Base Fee <br />A - Active <br />TC - Temporary Closure <br />PC - Permanent Closure <br />$ 100.00 <br />50.00 <br />50.00 <br />50.00 <br />$ 50.00 <br />TOTAL FEES DUE: <br />$300.00 <br />$ 300.00 <br />Notify the San Joaquin Local Health District <br />of any corrections or changes necessary. <br />Permit will be mailed upon receipt of payment <br />and approval of facility. <br />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 />