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� l <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 /> RALPH LEE WHITE RALPH21RALPH'S SQUARE <br /> <br /> STOCKTON, CA 95206 <br /> Billing statement for 1986-1987 Underground Tank Facility. <br /> Statement Date: HAY 11 1987 Date Due MAY 30, 1987 <br /> 1986 1987 $100.00 <br /> Facility $100.00 Facility (�ry <br /> Tank # *Status Tank p *Status <br /> 1 A S 50.00 1 A $ 50.00 <br /> - <br /> 2 50.00 00 <br /> 3 A -50-.-00 -3_ <br /> — ENVIRONENTAL HEALTH <br /> FERMIT/SERVICES <br /> State surcharges @ $56 per tank x 3 = $ 168.00 <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 Ifealth 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 /> Environemntal Health Permit/Services <br /> P 0 Box 2009, Stockton , CA 95201 <br />