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SAN JOAQUIN LOCAL HEALTH DIcTRICT <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Struckt-on, CA 95101 <br /> (209) 463-3425 <br /> Jo•ai Khanna, M.D. , Health it;i icer <br /> FRED A. 3HAy,1VER <br /> <br /> <br /> STOCKTON, , CA 95205 <br /> 3i i 1 ing Statefilent For 19x;3 Permit, Underground Tani: Facility. <br /> 3taterfient Date January i , 19313 <br /> Payment true Date: February i , 1989 <br /> Facility Fee: 100.00 <br /> Container Number: 0001 50.00 <br /> TOTAL FEE'S DUE $150.00 <br /> !OTES <br /> Notify the Sail Joaquin Local <br /> Health District of any <br /> corrections or changes <br /> ner_essary . Your Permit will <br /> L wailed upon receipt Of <br /> payment and approval of <br /> facility . <br /> Return paytient along with one <br /> copy of this Statement to: <br /> SAN JOAt1U N LOCAL HEAL.'!H DISTRICT <br /> ENVIRONMENTAL HEALTH F'ERKI7/SERVICES <br /> F.O. BOX 2003 <br /> STOC:KTON, CA 98201 <br /> Penalties will be added, after <br /> due date as shown: <br /> 0 days' - 100% of Erase Fee <br /> 1+ <br />