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:SAN JOAQUIN LOCAL HEALTH OTiTRICT <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 /> DEPARTMENT OF FORESTRY CASTLOI <br /> <br /> CORRAL HOLLOW RD. <br /> TRACY, CA 95376 <br /> Billing statement for 1986 & 1987 Underground Tank Facility. <br /> Statement Date: OCTOBER 26, 1987 Date Due NOVEMBER 15, 1987 <br /> 1986 100.00 1987 100.00 <br /> Facility Facility <br /> Tank # *Status Tank # *Status <br /> 1 A 5 50 1 A S 50 <br /> State surcharges @ $56 per tank x I $ 56_nn <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 Ifealth District of any corrections or Chang <br /> nece:;:;a r . <br /> Return payment along with one copy of this statement to: <br /> San Joaquin Local Health District <br /> Environmental Health Permit/Services <br /> P 0 Box 2009, Stockton, CA 95201 <br />