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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, M.D. , Health Officer <br /> RALPH LEE WHITE RALPH21 <br /> <br /> 2122 S. AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Billing statement for 1986-1987 Underground Tank Facility . <br /> Statement Date: MAY 11, 1987 Date Due MAY 30, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> 1 A $ 50.00 1 A $ 50.00 <br /> 2 A 50.00 �- =0 <br /> 3 A -TO-.00 3 <br /> PAYMENT <br /> RECEIVED <br /> JUN 3 1987 \'P/y <br /> State surcharges @ $56 per tank x 3 = $ 168.00 ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Subtotal of permit fees 1986 $ 250.00 <br /> Subtotal of permit fees 1987 $ 250.00 <br /> TOTAL FEES DUE: $668.00 <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 Box 2009 , Stockton , CA 95201 <br />