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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 - 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 /> L _ A SAO 00 —g_ S _ 50 X00 <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 /> TMAL FIiES DUE: $ 356.00 <br /> *A - Active <br /> TC - Temporary cl osu r•e <br /> PC - Permanent. Closure <br /> Notify the San Joaquin Local Ile <br /> n c c:;:;: r y . alth Uistrtrt. of any corrections or changes <br /> r <br /> Return payment ;tlong wi Ur on,, copy of thi :: statenurnt to: <br /> :ian .loaquin l,o<::il Ilealth Di::tri<:I. <br /> Environemntal Health Permit./Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br />