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t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Flazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna , M.D. , Health Officer <br /> CHEVRON CHEVR44 <br /> 4400 WATERLOO ROAD CHEVRON <br /> STOCKTON, CA 95205 4400 WATERLOO ROAD <br /> STOCKTON, CA 95205 <br /> Billing statement for 1987 Perrnit , Underground Tank Facility. <br /> Statement Date: MAY 1 , 1987 <br /> Due: JUNE 1, 1987 <br /> Facility 5 100.00 <br /> Container a *Status <br /> 1 A 50.00 <br /> 2 5._-5U.00 <br /> 3 �C-300 <br /> 4 �, 50.00 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit- fees: $300.00 <br /> Addit-ional Billings or Credits <br /> TOTAL FEES DUE : 5300.00 — <br /> Penalties will be added Notify the-Sari 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 (lase Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health Ui ,,trict <br /> Environmental Health Permit./Services <br /> A - Active P. 0. (lox 2.009, Stockton , CA 95201 <br /> TC - Temporary Closure <br /> P( - Permanent Closure <br />