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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P 0 Box 2009 <br /> Stockton , CA 95201 C <br /> (209)466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> t :1 <br /> NBTRIPL37 �j <br /> Faith Transportation Faith Transportation <br /> 3755 Munford 3755 Munford <br /> Stockton, CA 95205 Stockton, CA <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: September 15 1987 Date Due October 15 . 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100 .00 <br /> Tank # *Status Tank # *Status <br /> 1 A S 50 .00 1 _ A $ 50 .00 <br /> 2 A 50 .00 2 A 50 .00 <br /> State surcharges @ $56 per tank x--L= $ 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 /> PC - Permanent Closure <br /> Notify the Saul 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 O Box 2009 , Stockton , CA 95201 <br /> j- <br />