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i • <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 /> Randolph D. Savig . NBSAVIG15 <br /> 15922 N. Tretheway Rd. RANDOLPH D. SAVIG <br /> Lodi, CA. 95240 15922 N. TRETHEWAY RD. <br /> LODI, CA. 95240 <br /> Billing statement for 1986--- 1987 Underground Tank Facility . <br /> Statement Date: Aug. 25, 1987 Date Due Sept. 25, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100.0 <br /> Tank # *Status Tank # *Status <br /> 1 A $ 50. 1 A $ 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 <br /> TOTAL FEES DUE: $ 356.00 <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 /> Environemntal Health Permit/Services <br /> P 0 Box 2009 , Stockton, CA 95201 <br />