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KKK HEALTH SERVIuS <br /> SAN JOAQUIN CMTY <br /> US N. San Joaquin St. G. Rc;x K <br /> Stockton, CA 95241 <br /> Jai 0arna, M.D;, Health <br /> Officer <br /> FCT1~eC130 <br /> T1iE "T;- uWY!�A.�NtY� TIME 01 CINANY <br /> 7`57 W. CiMKJME WAY sOiS NAVY DRIVE - <br /> 3EATP E, 6A i+3 STOCCTON, CA 3bi% <br /> Rillirrr Statement for Servite- Peloo ending: -December 3f, 1951 - - <br /> _nvironmental health Permit to be issued for: <br /> S <br /> Statement Date; November 1, 1590 '73 �v.s �o.r San Toa�ut-. Co . <br /> Due Date; December 1, 1390 <br /> TOTAL DUE: -42'40C,00__ ©.00 <br /> Penalties will be added after Notify the Environmental Health <br /> UA& Cate as shorn: Division of any corrections or <br /> changes necessary. permit will be <br /> :x) days -100% of Rase Fee mailed upon Weipt of payment. <br /> Return paymeht along with one copy <br /> of this statement to: <br /> Public Health Services, San Joaquin <br /> Cotnt,y/Enyir {N1 Kcalth <br /> F. 0. Box 2009, Stockton, CA 95201k.,.r,_v <br />