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.t <br /> • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT RECEIVED <br /> 1601 E. Hazelton Avenue, P O Box 2009 < c <br /> Stockton, CA 95201 = o <br /> •(209)466-6781 JUL2 187 M <br /> n. <br /> Jogi Khanna, M.D. , Health Officer Maintenance <br /> — MODESTO — <br /> CAL TRANS - LODI MAINTENANCE CALTR84 <br /> 845 E. PINE STREET CAL TRANS - LODI MAINTENANCE <br /> LODI, CA 95240 845 E. PINE STREET <br /> LODI, CA 95240 <br /> Billing statement for 1 86 - tg87 <br /> Underground Tank Facility . <br /> Statement Date: ,IIINF 74 IgA7 <br /> Date Due JULY 15 1987 <br /> 1986 1987 <br /> Facility V00 00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> 1, A $ 50.00 1 <br /> 2 A A $ 50.00 <br /> 50.00 2 A 50.00 <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 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 /> Eavironemntal Health Permit/Services P A Y M E N T <br /> P 0 Box 2009, Stockton , CA 95201 RECEIVED <br /> AUG 11. 1987 <br /> ENVIRONMENTAL HEALTH <br /> PERMITAERVICES <br />