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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 /> CALTRANS DISCO20 <br /> • 1976 E. CHARTER WAY DISCOUNT TIRE <br /> • STOCKTON, CA 95205 204 S. WILSON WAY <br /> STOCKTON, CA 95205 <br /> Billing statement for 1986 R 1487 PERMIT Underground Tank Facility . <br /> Statement Date: MAY 19, 1987 Date Due JUT 30, 1987 <br /> 1986 1987 <br /> Facility $100 Facility $100 <br /> Tank # *Status Tank # *Status <br /> 1 A $ 50 _ 1 A $ — <br /> 2 A 50 _ 2 A_ 0 <br /> State surcharges @ $56 per tank x 2 = $ 112.00 <br /> Subtotal of permit fees 1986 $ 200.00 <br /> Subtotal of permit fees 1987 $ 200.00 <br /> TOTAL FEES DUE: $ 512.00 <br /> *A - Active <br /> TC - 'Temporary Closure <br /> 11C - I>ermanent Closure <br /> Notify the San Joaquin Local Health District of any corrections or changes <br /> nec(,ssary . <br /> Return payment along with one copy of this statement to: <br /> San .Joaquin Local Health District <br /> Environemntal Health Permit/Services <br /> 1) 0 Box 2009 , Stockton , CA 95201 <br />