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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P O Box 2009 <br /> Stockton , CA 95201 <br /> (209)488-8781 <br /> Jogi Khanna, M.D. , Health Officer <br /> AFTAB KHAN KHANA52 <br /> <br /> 521 N. CHEROKEE LANE <br /> LODI, CA 95240 <br /> Billing statement for 1986 1987 Underground Tank Facility . <br /> Statement Date: JUNE 24, 1987 Date Due JULY 15, 1987 <br /> 1986 1987 <br /> Facility —lip—0.0—0 Facility $100.00 <br /> Tank k *Status Tank p *Status <br /> —1_ A S 50.00 1 A S 50.00 <br /> 2 A 50.00 2 A 50.00 <br /> 3 4 —MOO —57.-bo <br /> 4 - —57-00 _7700 <br /> 2 -T - -07DO --5- -37DO <br /> 4 5,0 <br /> State surcharges 0 $56 per tank x -&-(t $ ?> 60 33(0. OU , <br /> Subtotal of 0O <br /> permit fees 1986 $ 35f1:00 tl' <br /> Subtotal of permit fees 1987 $ 3,50-00 10" <br /> TOTAL FEES DUE: $_Pu.u0 <br /> •A - Active �- <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San Joaquin Local Ilealth District of any corrections or changes <br /> necessary . <br /> Return payment along with one copy of this statement to: <br /> San Joaquin Local Ilealth District <br /> Eavironemntal Health Permit/Services <br /> I) O [lox 2009 , Stockton , CA 95201 <br /> PAYMENT <br /> RECEIVED <br /> JAN 2 2 1988 <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br />