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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— g_50_00 —A-- SO, 0 f <br /> REGE\J <br /> 1981 /e <br /> State surcharges @ $56 per tank x 1 $ 56.00 PR?MT�S <br /> Subtotal of permit fees 1986 $ 15O.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 /> Return payment along with one copy of this statement to: <br /> San .Joaquin Local Health District <br /> Environemntal health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br />