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0 <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 />-CITY OF MHNTLCA - MANTE21 <br />.C/O UAVID MUELLER CITY OF MANTECA <br />• UIRECTUR OF PUBLIC WORKS 210 E. WETMORE <br />•1001 WEST CENTER STRtET MANIECA, CA 95336 <br />MANTECA, CA 95336 <br />Billing statement for - Underground Tank Facility. <br />Statement Date: Date Due JUNE 30 1987 <br />1986 <br />Facility $100.00 <br />Tank # *Status <br />1 A 50.00 <br />2 _7F_ <br />� --A- -5u_.UO <br />1987 <br />Facility 100.00 <br />Tank # *Status <br />1 A g 50.00 <br />-- -A--- X00 <br />__T_ —5D C10 <br />State surcharges @ $56 per tank x 3= <br />Subtotal of permit fees 1986 <br />Subtotal of permit fees 1987 <br />*A - Active <br />TC - Temporary Closure <br />PC - Permanent Closure <br />PAYMENT <br />RVECEIVEo <br />�JUL _ t) `r 1987 <br />$ 1613.00 .ENVIRONMENTAL HEALTH <br />$ 250.00 PERMIT/SERVICES <br />$ 250.00 <br />TOTAL FEES DUE: <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 Ilealth District <br />Environemntal health Permit/Services <br />P 0 Box 2009, Stockton, CA 95201 <br />41 Q <br />