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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SI-4 <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 ®v 3 198 <br /> (209) 466-6781 LTN <br /> Jog1 Khanna, M.D. , Health OfficerWENTAL HEA <br /> ENv1 P®MtT ISE.RVICES <br /> f <br /> BOK I D9 8 <br /> ' MEL BOKIDES PETROLEUM INC. ' MEL BOKIDES PETROLEUM INC . <br /> 983 MOFFAT BLVD 6983 MOFFAT BLVD <br /> MANTECA , CA -95336 ' MANTECA, CA 95 336 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: March 15, 1987 <br /> Due: Aori 1 <br /> Facility $ 100 <br /> Container # *Status <br /> 1 r <br /> 2 -A— 50 . r, <br /> 3 A 450 <br /> 4 A <br /> • a <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 3)0 <br /> -Additional Billings or Credits <br /> S <br /> TOTAL FEES DUE: $ 300.00 <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 /> 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 i <br />