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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 /> • ARCOS61 <br /> * ARCO PETROLEUM PRODUCTS COMPANY ARCO STATION #595 <br /> P. 0. BOX 8511 6100 N. HIGHWAY 99 <br /> . SAN MATEO, CA 94402 STOCKTON, CA 95212 <br /> Billing statement for 1987 PERMIT Underground Tank Facility. <br /> Statement Date: JULY 30, 1987 <br /> Due: AUGUST 30, 1987 REVISED STATEMENT <br /> (Disregard statement dated <br /> 5/1/87) <br /> Facility $ 100.00 <br /> Container # *Status <br /> � <br /> A� $ 50.000 PAYMENT 1 <br /> RECEIVED )611P`) <br /> $ bU.0 AUG 111987 � � � <br /> 3 <br /> $ .ENVIRONMENTAL HEALTH <br /> $ PERMIT/SERVICES <br /> State surcharges @ $56 per tank x _ _ <br /> �- PAYMENT <br /> Subtotal of permit fees: $ 250.00 R E C E I V E D p: <br /> Additional Billings or Credits SEP 14, 1987 �� <br /> CREDIT FROM 1986 OVERPAYMENT - $ 106.00 ENVIRONMENTAL HEALTH <br /> TOTAL FEES DUE: $144PFWITJSERVICES <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> past 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 P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />