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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P O Box 2009 <br /> Stockton, CA 95201 <br /> (209)466-6781 <br /> Jogi Khanna, N.D. , Health Officer <br /> . RIPON PICKLE CO. NBRIPON50 <br /> • <br /> 5050 CARPENTER. RD. <br /> S OCKION, CA. 95205 <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: AUG. 25, 1987 Date Due SEPT. 25, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100.00 <br /> Tank p *Status Tank # *Status . <br /> A S 50 _ 1 A-- $ 50 <br /> State surcharges @ $56 per tank x 1 = $ 56.00 <br /> Subtotal of permit fees 1986 $ 150.00 <br /> Subtotal of permit fees 1987 $ 150.00 <br /> TOTAL FEES DUE: $ 356.00 <br /> *A' - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San Joaquin Local Health Di :;trtrt of any corrections or changes <br /> noces:;:c ry .. <br /> ReLUrn payment :clone, w•i Lh one copy of this; sLateinent. Lo: <br /> San Joaquin Local Ifealth Ui :;tricL <br /> Environemntal Health Permit/Services <br /> P 0 Box 2009, Stockton , CA 95201 <br />