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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.O. , Health Officer <br /> BEACON . BEAC033 <br /> 525 WEST THIRD STREET BEACON CARDLOCK STATION #610 <br /> HANFORD, CA 93230 . 3300 WATERLOO ROAD <br /> STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit ,Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 <br /> Due: JUNE 1, 1987 <br /> Facility S 100.00 <br /> Container N Status <br /> 1 A 150.0 <br /> .Z_ S 50.00 <br /> —3— S 50.00 RECEIVE6 <br /> _4_ 7' So <br /> ,SUN 4 1997 rr <br /> — <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> State surcharges @ $56 per tank x = �_ <br /> Subtotal of permit fees: S300.00 <br /> Additional Billings or Credits <br /> Additional fee for underpayment for 1986 S 106.00 <br /> (1 tank and surcharge.) - - - -- <br /> '--TOTAL FEES DUE: 5406.00 :µG <br /> Penalties will be added "I 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 /> Sari Joaquin Local Health District <br /> • Environmental Health Permit/Services <br /> A - Active P. 0. Box 2009, Stockton. CA 95201 <br /> { TC - Temporary Closure <br /> �'r - Permanent. Clnsur-o <br />