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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P O Box 2009 <br /> I Stockton , CA 95201 <br /> (209)466-6781 <br /> r Jogi Khanna, M.D. , Health Offic_r <br /> SANTA FE RRSZoo G. 5.+ . . �T.SANTAO1 <br /> P. 0. BOX 1947 SANTA FE RR <br /> FRESNO, CA 93718 �'`' �NG'��`' N/E CORNER, OF SCOTTS & S.P. TRACKS <br /> STOCKTON, CA <br /> ' b7TN•'T, IASb�.L <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: _ JUNE 24 , 1987 Date Due JULY 15, 1987 <br /> 1986 1987 <br /> Facility &100.00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> 1 A S 50.00 1 A S 50.00 &EScEL <br /> 2_ A 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 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 /> n Environemntal Bealth Permit,/Services <br /> � ; <br /> r M4RM O P O Box 2009 , Stockton , CA 9520 <br /> --r—� APPROv�u: <br /> APPROVED <br /> 1 _. ngl„eeritl� <br /> dA- <br /> 41 ONM N-TAL EN6INEER - <br /> �; <br /> i <br />