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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 DON'S AM-PM ARCO #595 <br /> P.O. BOX 8511 6100 NORTH HWY 99 <br /> SAN MATEO, CA 94402 STOCKTON, CA 95212 <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 /> Container N *Status <br /> 2 A50.00 <br /> 3 A 50.00 <br /> A 50.00 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: <br /> $ 250.00 <br /> Additional Billings or Credits <br /> Credit-from 1986 overpayment <br /> S 212.00 <br /> -- � �gyp• t� c) `� 4? <br /> TOTAL FEES DUE: S 38.00 <br /> Penalties will be added Notify the San Joaquin Local �Liea_1_th District <br /> ct <br /> past due date 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 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 />