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j SAN JOAQUIN LOCAL HEALTH DIaTR1C:T <br /> I 1b01 E. Hazelton Ave , P.O. Box 2009 <br /> r2 <br /> '�tC+c�a.i+n, CA 3501 i <br /> (209) 468-3425 <br />` Joy Khanna, M.D. , Health Officer <br /> Y <br /> SEIFE85 <br /> EIFERT DAIRY FARM SEIFERT DAIRY FARM <br /> SELF E. COLLIER ROAD 8505 E- COLLIER ROD <br /> ACAMPO, CA 95220 <br /> ACAMPO+ CA 95'-20 <br /> Billing statement For 1959 Permit.: Underground Tank: Facility . <br /> Statement Date , July 12 1989 <br /> F?.rr�erw <br /> Facility Fee: 10 ,00 <br /> Container Number, 0001 O.00 A <br /> 0002 5iu <br /> -TOTAL FEES DUE $200.00 <br /> NOTES <br /> Notify the Saiz Joaquin. Local <br /> P,4 Y <br /> f Health District of any RFCe,VeD <br /> corrections or changes AUG <br /> necessary . Your permit. will <br /> Jp, <br /> be mailed upon receipt. of ENVIRD <br /> Payment and approval ofE NMfN rq <br /> P n , � <br /> facility. M/?/SE4Vj�F5gL ry <br /> Return payment along with one <br /> cost of this StatetfieYtt to. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> - i Penalties will be added after <br /> due date as shown: <br /> 30 days - 100% of Base Fee <br /> 1 <br />