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6 <br /> 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 /> ESCALON TIRE SUPPLY <br /> 1910 MAIN STREET 1910MAIN STREET <br /> ESCALON TIRE SUPPLY v <br /> . ESCALON, CA 95320 1910 M <br /> ESCALON, CA 95320 <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: JUNE 2, 1987 Date Due JUNE 30, 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 00 �— --A-- --0700 <br /> SG <br /> State surcharges @ $56 per tank x 2= $ 112.00 <br /> Subtotal of permit fees 1986 $ 200.00 n►,e <br /> Subtotal of permit fees 1987 $ 290.00 27 <br /> TOTAL FEES DUE: $ <br /> k X04 <br /> *A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure 1ct <br /> Notify the San Joaquin Local Health District of any corrections or changes <br /> necessary . <br /> Return payment along with one copy of this statement to : <br /> t�h San .Joaquin Local Ilcalth District <br /> (� Environemntal Health Permit/Services <br /> Y I> O Box 2009, Stockton , CA 95201 <br /> 1Cj Q��7 o) <br /> 0 0 <br />