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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 - <br /> Stockton, <br /> 009Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> • HAMME77 <br /> Hammer Lane Shell HAMMER LANE SHELL <br /> 7700 Moreland Ct. 7700 MORELAND CT. <br /> Stockton, CA 95212 STOCKTON, CA 95212 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: 7/15/87 <br /> Due: 8/15/87 <br /> Facility $ 100.00 <br /> Container # *Status <br /> 1 A 50.00 <br /> $ 50.00 <br /> T— 50.00 <br /> —4 $ 0 (To Be Removed) <br /> 5 $ 50. 0 PAYMENT <br /> $ <br /> $ RECEIVED <br /> State surcharges @ $56 per tank x 1 = $ 56.00 JUL 2 7 1997 <br /> Subtotal of permit fees: $ 356.00 .ENVIRONMENTAL HEALTH <br /> Additional Billings or -Credits - PERMIT/SERVICES <br /> - $ 270 Credit Balance <br /> TOTAL FEES DUE: $ 86'00 <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 <br /> P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />