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0 0 <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 /> RODNEY CROCKER HENRYI2 <br /> 7 E. INGRAM HENRY APARTMENTS <br /> STOCKTON, CA 95204 121 S. SUTTER ST. <br /> STOCKTON, CA <br /> Billing statement for 1987 Underground Tank Facility . <br /> Statement Date: SQptpmb r 10. 1987 Date Due Octnhpr 10, 1987 <br /> Facility <br /> Tank # *Status Tank # *Status <br /> —1 . P C, ga0 00 -- b--- <br /> State surcharges @ $56 per tank x_= $ <br /> Subtotal of permit fees 1987 $ 90.00 <br /> TOTAL FEES DUE: $ 90.00 <br /> *A - Active <br /> TC - Tompor:u•y t' 1 osu rC <br /> PC - Pormanent Closur,• <br /> Notify Lhe San Jo:uluin I,0C:1l health Di :;Lrtcl of any corrections or chango:; <br /> 11CC0:;:u, ry . <br /> ReLurn payment alojig 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 952O1 <br />