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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, N.D. , Health Officer <br /> • PAT DE PALMA NBOEPAL18 <br /> • 18666 E. HWY 120 PAT DE PALMA <br /> • RIPON, CA 95366 18666 E. HWY 120 <br /> RIPON, CA 95366 <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date : August 25, 1987 Date Due September 25, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> 1 A S 50.00 1 A _ S 50.00 <br /> 2 A 50.00 � A 50.00 <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 /> T()PAL FEES DUE: $ 512.00 <br /> *A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San ,Joaquin Local IIca1L11 District of any corrections or changes <br /> necessary . <br /> Return pavment. along with oiw copy of Lhi :. sLaLenu•nt to ' <br /> San .Joaquin Local health Di :;LricL <br /> linvironemntal health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 952O1 <br />