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I <br /> SAN JOAQUIN LOCAL HEALTH DISTRIC , <br /> 1601 E. Haze i ton Ave. , P.C. Box 24:)9 <br /> Stockton, CA 95241 <br /> (209) 463-3425 <br /> Jogi Khanna, M.U. , Health Officer <br /> SCARC-2 CFXiZ�az R <br /> X-X-XxKXX)(Xy=x XX Borth Cal Construction <br /> XXXXXXX-XXXXXX P.O. BOX 588 22! N CARDINAL <br /> XXXXXXXXXXXXXXX St%kton, CA 95201 STOCKTON, C.P. 98245 <br /> .tater(,ent For 1'+oi Permit, Underground Tank Facility. <br /> St.at.erf;ent. Date January 1, i9^� <br /> Payment. Due Date: February i , 1yc4 <br /> facility fee! i0o.00 <br /> Container Number: 0001 50.00 <br /> 0402 *10.00 <br /> p <br /> 0003 50.00 <br /> TOTAL FEES DUE $250.40 <br /> IC}TES, <br /> Notify the :-an Joaquin Local <br /> Health District of any <br /> corrections or changes ' <br /> necessary . Your Permit will <br /> be trailed upon receipt of <br /> payment and approval of <br /> facility . <br /> Return payment along with one <br /> copy of this s'tateme'nt to; <br /> 'SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> P.O. BOX 2049 <br /> STOCKTON, CA 35201 <br /> Penalties will t+e added after <br /> due date as shown <br /> "f.) days. - 1`00« of Base fee <br />