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r ' • • - - <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. RANDOLPR D. SAVIG <br /> Lodi, CA. 95240 15922 N. TRETHEWAY RD. <br /> LCDI, 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 $100.00 <br /> Tank # *Status Tank # •Status <br /> 1 A 5 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 - Tempor;ury Closure <br /> PC - Permanent Closure <br /> Notify the San .Joaquin Local Health Di5tr1CL of ally corrections or changes <br /> ncces:;a ry .. <br /> Return payment along with otw copy of this statettwnt to: <br /> San Joaquin Local Health District <br /> Lnvironemntal Health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br />