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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P O Box 2009 <br /> Stockton , CA 95201 <br /> (209)466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> <br /> <br /> <br /> LODI , CA 95240 <br /> Billing statement for 1986 - 192 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 N *Status Tank # *Status <br /> 1_ g-5-0 00 1 _A _ S._50 00 <br /> State surcharges @ $56 per tank x 1 = $ 56.00 <br /> Subtotal of permit fees 1986 $ 150.00 <br /> Subtotal of permit fees 1987 $ 150.00 <br /> •r(rrAL FEES DUE: $ 356.00 <br /> *A - Active <br /> TC - Tempor:u'y Closure <br /> PC - Permanent. Closure: <br /> Notify the San Joaquin Local IlcalLh D1 :et1' 1cL of any corrections or changes <br /> ❑ecea:ucry . <br /> Return payment along with un(• copy of Lhi :; :;tIlICIMrnt t.o: <br /> San Joaquin Local Health I)i :;tricL <br /> linvironemntal Health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br /> 0 0 <br />