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0 i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P O Box 2009 <br /> Stockton , CA 95201 <br /> (209)466-6781 <br /> J091 Khanna, M.D. , Health Officer <br /> CAL TRANS - LODI MAINTENANCE <br /> 845 E. PINE STREET CALTR84 <br /> LODI , CA 95240 CAL TRANS - LODI MAINTENANCE <br /> 845 E. PINE STREET <br /> LODI, CA 95240 <br /> Billing statement for —_1986 - 19R7 <br /> Statement Date: 1lINUnderground Tank Facility. <br /> F 74 1987 Date Due <br /> JULY 15 1987 <br /> 1986 <br /> Facility _$7no No 1987 <br /> Tank # • Facility $10_ 0,00 <br /> Status <br /> I A Tank # *Status <br /> -2— S 50.00 A <br /> A 50.00 2 $ 50.00 <br /> — A 50.00 <br /> _ PAYMENT <br /> RECEIVED <br /> State surcharges 0 $56 <br /> per tank x 2 = $ 112.00 AUG 11. 1987 <br /> Subtotal of permit fees 1986 <br /> Subtotal of $ 200.00 ENVIRONMENTAL HEALTH <br /> permit fees 1987 $ 200.00 PERMITJSERVICES <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; stat mrnt to : <br /> San Joaquin Local "cal " District <br /> Environemntal Health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br />