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`. V <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P 0 Box 2009 <br /> Stockton , CA 95201 <br /> (209)466-6781 <br /> Jogi Khanna, M.D . , Health Officer <br /> Carl Yearing KHANA52 <br /> <br /> 521 N. Cherokee <br /> Lodi , CA 95240 <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: August 25 , 1987 Date Due Septamber 25, 1987 <br /> 1986 1987 <br /> Facility $100. Facility $100. <br /> Tank M *Status Tank q *Status <br /> 1 A S50._ -I— A-- S 511- <br /> 2 A 50. 2 A50 <br /> 3 A 50. 3 A <br /> 4 _A 50 4 A 50 . <br /> 5 A 50 . 5 A 50 . <br /> Le <br /> State surcharges ® $56 per tank xe aD <br /> Subtotal of permit fees 1986Q�'� > <br /> Subtotal of permit fees 1987 $3&CF-0 0_ ' CID <br /> TOTAL F'Itil•:S UUli: $ Oi�' I3��O <br /> *A - Active <br /> TC - Temporary losurr• <br /> PC - PI-1- C <br /> mancnt l'lo::urt• I 1 s•pp <br /> I'ti '0 <br /> Notify Lhc San .loayutn LOCaI Ilealth ) :L rtcrt of ;rtty corrf•c tion:; or change:: <br /> ncCOssary . <br /> Return payment alone,, with ono copy of t.bi :; :;Lat nt nt. to : <br /> San Joaquin Local Health District. <br /> Environemntal Health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br /> L �i <br />