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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 /> • HILLIER FORD <br /> • 3000 MCHENRY HILLIER FORD <br /> • ESCALON, CA 95320 3000 MCHENRY <br /> ESCALON, CA 95320 <br /> Billing statement for 1986 - 1987 Underground Tank Facility. <br /> Statement Date: JUNE 2, 1987 _ Date Due JUNE 30, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> A_ $_.50.00 1 A $-5D.00 <br /> State surcharges @ $56 per tank x I $ 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 /> hangesnecessary . <br /> Return payment along with one copy of this statement to : PAYS <br /> EG <br /> San Joaquin Local Health District R ,gad <br /> Environemntal Health Permit/ServicesJu�Q, <br /> P O Box 2009, Stockton , CA 95201 w€ALTS <br /> ENV�PnM1T�5ERV1C�� <br /> 0 • <br />