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Pt16LIC: HEALTH SERvICEc., SAN JOAQUIN COUNTY <br /> I 445 N. Sari Joaquin Street :NOT A MAILING AODRESSi <br /> P.O. Box '00'a <br /> I Stockton, CA 95201 I <br /> (2109) 468-3471 <br /> JCgi Khanna, M.G. , Health Officer <br /> I I <br /> & R E06 <br /> <br /> <br /> ACAMP0. CA '+s220 <br /> Billing t For 1991 Permit. t, a I <br /> I n-iergroun,� Tank Fac i i i t.y , I <br /> Statement Clete January <br /> Pnymeiit. Due Date; February 7, 199( <br /> I I <br /> COntaif"er Tee 000- 1 %0.00 I <br /> I <br /> TOTAL FEE',; IJI'E -- ------ <br /> I I <br /> I I <br /> I <br /> I i <br /> NOTES; I <br /> Notify Public Health :aei'vi Ces. <br /> San Joaquin' County t.y Of any <br /> correction,. or cnan3es <br /> necessary. Your Permit will I <br /> be mailed upGii receipt of <br /> PaYfdent and approval of <br /> facility. <br /> I <br /> Return payment along with one <br /> COPY Of this statement to: <br /> PUBLIC: HEALTH SERVICE'S <br /> SAN JOAQUIN C)iUNTY I <br /> ENVIRONMENTAL HEALTH PERMITiSERVIC:ES I <br /> P.O. Bi iX 2009 <br /> Sl O(X f ON, C.A _ati2(11 I <br /> Penalties will be added after <br /> due date as shcvm <br /> 30 days - 100% of Base Fee <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br />