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PgLIN <br /> 'c �COUNTY OF SAN JOAQUIP ACCOUNT NUMBER <br /> r.' <br /> Q, Z� OFFICE OF EMERGENCY SERVICE <br /> ROOM 610, COURTHOUSE 6`571 <br /> 222 EAST WEBER AVENUE <br /> • c"<1FoaN " STOCKTON, CALIFORNIA 95202 <br /> 9 1992 <br /> BUSINESS EMERGENCY PLAN FEESsAr; "i; CO_INT_Y <br /> ce ncv SERV CF <br /> BUSINESS NAME BUSINESS PHONE NUMBER <br /> CASWELL MEMORIAL STATE PARK 209-399-3810 <br /> BUSINESS CONTACT NAME <br /> R.J.CHAPMAN,PK ANN <br /> BUSINESS ADDRESS CITY .STATE ZIT <br /> 28000 S RUSTIN RD RIPON CR 93366 <br /> LONG $240.00 FEE PLUS ` SHORT $60.00 FEE PLUS <br /> BUSINESS EMERGENCY PLAN TYPE: ❑ FORM ($15.00 PER HAZARDOUS MATERIAL) FORM $10.00 PER HAZARDOUS MATERIAL/` <br /> NUMBER OF HAZARDOUS MATERIALS: 2 <br /> AMOUNT DUE • • W97 <br /> $ 70.00 + ( 2 X $ 13.00 ) $100.00 <br /> FEE NUMBER OF MATERIAL FEES <br /> HAZARDOUS MATERIALS <br /> 04/24/WWHITE COPY MUST BE RETURNED WITH YOUR <br /> DATE DUE: -_0 KEEP YELLOW COPYFOR YOUR RECORDS. <br />