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ti <br /> 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 /> . HOWARD E. RICHARDSON RICKS26 <br /> . 2662 N. WILSON WAY RICK'S NORWALKS SERVICE <br /> . STOCKTON, CA 95205 2662 N. WILSON WAY <br /> STOCKTON, CA 95205 <br /> Billing statement for 1986 & 1987 PERMIT Underground Tank Facility. <br /> Statement Date: MAY 19. _1987 Date Due` JUNE30, 1987 <br /> 1986 1987 <br /> Facility $100.00 Facility $100.00 <br /> Tank # *Status Tank # *Status <br /> 1 A 3 50.00 1 A $�0•QO <br /> 2 A 50.00 9 _ A 50.00 <br /> State surcharges @ $56 per tank x2_= $ 112.00 <br /> Subtotal of permit fees 19.86 $ 2nn-nn <br /> Subtotal of permit fees 1987 $ 200.00 <br /> TOTAL FEES DUE: $ 512.00 <br /> *A - Active <br /> TC - 'Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San Joaquin Local [iealth District of any corrections or changes <br /> necessary . <br /> Return payment along with one copy of this statement to: <br /> San Joaquin Local health District <br /> Environemntai health Permit/Services <br /> P 0 Box 2009 , Stockton , CA 95201. <br />