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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, Y.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 $100.00 Facility $100.00 <br /> Tank N *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 A -M-00 2 A X00 <br /> 4 A — (*�T.b0 _6:_00 <br /> 5 _3700 <br /> State surcharges 0 $56 per tank x 5 a $ 280.00 <br /> Subtotal of permit fees 1986 $ 350,00 <br /> Subtotal of permit fees 1987 $ 350.00 <br /> TOTAL FEES DUE: $ 980.00 <br /> •A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San Joaquin Local Health District of any corrections or changes <br /> necessary . <br /> Return payment along with one copy of this statement to : <br /> San Joaquin Local Rcalth District <br /> Environematal health Permit/Services <br /> 11 0 Dox 2009 , Stockton , CA 95201 <br />