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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, M.D. , Health Officer <br /> DONNA GARDNER NBGARDN26 <br /> 1206 STRUCK DONNA GARDNER <br /> ORANGE, CA 92667 26056 N. THORNTON ROAD <br /> THORNTON, CA 95686 <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 /> g_50_00 -1- -A--- $ -aw0 <br /> 50-00 -2- <br /> State <br /> 2_State surcharges @ $56 per tank x_j_= $ 112.00 <br /> Subtotal of permit fees 1986 $ 200.00 <br /> Subtotal of permit fees 1987 $ 20_ 0,0D__ <br /> 'rtYTAI, FEES DUH.': $ 512.00 <br /> `A -- Active <br /> TC - Temporary V l os" r-c, <br /> PC - Permanent Closure <br /> Notify the Nan Joaquin Wral Health District of any corrections or chanq .; <br /> nc•c(I>i:i;t r'y Y . <br /> k{eturu paymexit along with ona copy of this Matpmont to : <br /> :y;>n .Ioaquin Loc;aI IIeaIth 1) i :;tri.c.t <br /> Environemntal Health Permit/Services <br /> P 0 Itox 2009 , Stockton , CA 95201 <br />