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` ' PpUIN <br /> �o.• " �z.coG <br /> COUNTY OF SAN JOAQUIN ACCOUNT NUMBER <br /> r. y OFFICE OF EMERGENCY SERVICE <br /> Q: 2292 <br /> N: < <br /> ROOM 610, COURTHOUSE <br /> . 222 EAST WEBER AVENUE <br /> • cgtiFd"ad�P• STOCKTON, CALIFORNIA 95202 <br /> BUSINESS EMERGENCY PLAN FEES FEB 18 <br /> L <br /> BUSINESS`PHONE NUMBER <br /> BUSINESS NAME' <br /> BLRCKM M EWIPt1ENT LERSINO 209-407-11'1 <br /> BUSINESS CONTACT NAME <br /> MICHAEL BLACKNUM <br /> BUSINESS ADDRESS CITY STATE ZAP 95206 <br /> 1055 S STOCKTON STREET STOCKTON <br /> LONGSHORT <br /> BUSINESS EMERGENCY PLAN TYPE: ❑ FORM ❑ FORM <br /> NUMBER OF HAZARDOUS MATERIALS: 4 <br /> AMOUNT DUE <br /> $210.00 <br /> + ` 4 X $ 15.00 _ $300.00 <br /> FEE NUMBER OF MATERIAL-EES <br /> HAZARDOUS MATERIALS <br /> 03/mm 1 WHITE COPY MUST BE RETURNED WITH YOUR <br /> DATE DUE: KEEP YELLOW • ' • YOUR • • <br /> S. <br /> 1 , I <br /> f <br /> If you have any questions or wish to discuss the calculations, please <br /> call 468-39691to make an appointment. <br /> Thank you for your cooperation. <br /> CSJ/OES-01 <br /> RFTI IRN WITH YOUR REMITTANCE <br />