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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 /> PAWA BRA • NBPASMAll <br /> 113 NORTH WALNUT PASHA BROIHERRS, INC. <br /> RIPON, CA. 95366 113 NORTH WALNUT <br /> RIPON, CA. 95366 <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: AUG 25 1987 Date Due SEPT. 25, 7987 <br /> 1986 1987i/�_ - <br /> Facility $100.00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> 1 A 3--5Q_ 1 A _ b_5C— <br /> _2_ A _50 _2 A 50 <br /> State surcharges @ $56 per tank x 2 $ 112.00 <br /> Subtotal of permit fees 1986 $ 200.00 1Q <br /> Subtotal of permit fees 1987 $ 200 nn o <br /> TOTAL FEES DUE: $ 512.00 <br /> *A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San Joaquin Local Ifealth District of any corrections or changes <br /> necessary . <br /> Return payment along with one copy of this statement to: <br /> San Joaquin Local Ifealth District <br /> Environemntal Ifealth Permit/Services <br /> P O Box 2009, Stockton , CA 95201 <br /> YVpFaawzq <br /> SEP 3 1987 <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br />