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u <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 /> TRACY01 <br /> CITY OF TRACY CITY OF TRACY BALL PARK WELL <br /> 560 S. TRACY BLVD. TRACY BLVD. & GRANTLINE <br /> TRACY, CA 95376 TRACY, CA 95376 <br /> Billing statement for lgFt6 & 1987 PERMIT Underground Tank Facility . <br /> Statement Date : MAY 19, 1487 Date Due MAY 30. 1987 <br /> 1986 1987 <br /> Facility $100 Facility $100 <br /> Tank 11 *Status Tank # *Status <br /> 1 A S 50 1 A $ 50 <br /> PAYMENT <br /> RECEIVED <br /> ---- - - JUN 191987 <br /> ENVIRONMENTAL HEALTH <br /> State surcharges @ $56 per tank x 1 = $ 56.00 PERMIT/SERVICES <br /> Subtotal of permit fees 1986 $ 150.00 <br /> Subtotal of permit fees 1987 $ 150.00 <br /> TOTAL. FEES DUE: $ 356.00 <br /> *A - Active <br /> TC - Temporary C1o,;urc <br /> PC - Permanent Closure <br /> Notify the San .Joaquin Local Ilcalth nJ :;triCt Of any corrections or changes <br /> neck:;:ary . <br /> Return payment :clone; with one copy of this statement to : <br /> San .Joaquin Local Health District <br /> Environemntal Ilcalth Permit/Services <br /> P 0 Dox 2009 , Stockton , CA 95201 <br />