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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue , P 0 Box 2009 <br /> Stockton , CA 95201 <br /> (209)966-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> • O.M. 4INCHELL & SONS 4dATER10WATERLOO MARKET <br /> • p. 0. BOX 5523 10415 WATERLOO RD. <br /> • STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> 1986 & 1987 PERMIT Underground Tank Facility . <br /> Billing statement for <br /> in Date Due <br /> Statement Date : <br /> 1986 1987 $100.00 <br /> Facility $100`00 Facility <br /> Tank # *Status Tank # *Status <br /> 1 A 50-- 1 A— PAYMENT <br /> A50 RECEIVED <br /> fY OCT J41987 <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> State surcharges $56 per tank x 3 = $_L68 00 <br /> Subtotal of permit fees 1986 $_z5Q_0.Q— <br /> $ 250.00 <br /> Subtotal of permit fees 1987 � 665.00 <br /> TOTAL FEES DUE: $ <br /> * A - Active <br /> 'rC - '1`clmp01ra1_y <br /> 1,(_' - 1 ermanent Clors►►r<' <br /> Notify the S:►n. Jo:►(luin 1.uc:a1 11ea1 th 1)► ,,tric- t 01 any correction's or chang(,r: <br /> ric•c'eti:s:►ry . <br /> Return payment alonj; Zvi th ono copy of' this sLatclitwnt to : <br /> San Joaquin Local Health District <br /> ti Environmental Health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201 <br />