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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 /> • BENJAMIN HILLMAN HILLM25 <br /> • <br /> 257 W. CLAYTON <br /> STOCKTON, CA 95206 <br /> Billing statement for 1986/1987 Underground Tank Facility . <br /> Statement Date: MAY 151987 Date Due JUNE 15, 1987 <br /> 1986 1987 <br /> Facility A100.00 Facility $100.00 <br /> Tank # *Status Tank 11 *Status <br /> 1 A S 50.00 1 A $ 50 <br /> 2 2 X00 �- <br /> State surcharges @ $56 per tank x 2 = $ 112.00 <br /> Subtotal of permit fees 1986 $ 200.00 <br /> Subtotal of permit fees 1987 $ 200.00 <br /> TOTAL FEES DUE: $ 512.00 <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 health District <br /> Eavironemntal health Permit/Services <br /> P 0 [lox 2009, Stockton , CA 95201 <br />