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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 /> Randolph D. Savig . NBSAVIG15 <br /> 15922 N. Tretheway Rd. RANDOLPH D. SAVIG <br /> Lodi, CA. 95240 15922 N. TRETHEWAY RD. <br /> Ia)j, CA. 95240 <br /> Billing statement for 1986 1987 Underground Tank Facility . <br /> Statement Date: <br /> Aug. 25, 1987 Date Due Sept. 25, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100'00 <br /> Tank # *Status Tank # *Status <br /> 1 A 5 50. 1 —A 5 50_ <br /> State surcharges @ $56 per tank x 1 = $ 56.00 <br /> Subtotal of permit fees 1986 $150.00 <br /> Subtotal of permit fees 1987 $150.00 356 � <br /> TOTAL FRES DUE: $ <br /> *A - Active <br /> TC - 'l'emporary Closure <br /> PC - Permanent Closure <br /> Notify Lhe San Joaquin Local Health Dititric: L 01 any corrections or changes <br /> necessary . <br /> ROLurn payment along with one Copy 01' thi.:; statement t.o : <br /> San Joaquin Local Ilealth Di:;trict <br /> linvironemntal Health Permit/Services <br /> 1' 0 Box 2009 , Stockton , CA 95201 <br />