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s <br /><x r <br /> ti+ SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> 1601 E. Hazelton Avenue, P 0 Box 2009 <br /> Stockton,, CA 95201 <br /> (209)466-6781 /A, x <br />` Jogi .Khanna, M.D. , Health Officer ` ✓ �~ +� <br /> . H014ARD E. RICHARDSON RICKS26 <br /> 8600 N. WEST LANE - SPACE #103 HOWARD E. RICHARDSON <br /> . STOCKTON, CA 95210-2241 2662 N. WILSON. WAY <br /> • STOCKTON, CA 95205 <br /> Billing -statement for 1986 - 1987 permit Underground Tank Facility . <br /> Statement Date: MAY 26. 1987 Date Due 11INF 3(l, 19R7 <br /> 1986 1987 <br /> Facility _$100,00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> —�— .A_ S 50,00 1 _A_ b 50_00 <br /> 2 A_ 50.00 —2 --IL, ---.50.00 <br /> State surcharges @ $56 .per tank xLL= 112.00 <br /> Subtotal of permit fees 1986 $ 200.00 <br /> Subtotal of permit fees. 1987 $ 200.00 <br /> TOTAL FEES DUE: $ 512.00 <br /> *A - Active <br /> TC - Temporary CI Osure <br /> PC - Permanent CI osu re <br /> Notify the San Jo.jquin Local Health Di:,trict of any corrections or changes----- <br /> necessary . <br /> Return payment a1ong with one copy of this statement to: <br /> San Joaquin Lo(;a 1 Health District <br /> Eaviroaemotal Health Permit/Services <br /> P 0 Box ,2009 , Stockton, CA 95201 <br />