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PUBLIC HEALTH SERVICES SRN TOAQUlN COUNTY � <br /> 44S N. Sar; J!,-" Nin Street (NOT A MAILING AODRE'" , <br /> "WO P O. Box 2009 <br /> Stockton; CA 95201 I <br /> y,K 1209 i 468-3427 <br /> Jogi Khanna, M.O. , Health Officer <br /> I I <br /> WILLIAM RELF SIMPS40J.H. 'SIMPSON COMPANY <br /> 402b CORONADO AVENUE 4025 C:ORONADO AVENUE <br /> STOCKTON, , CA 99204 STOCKTON, , CA 95204 <br /> I I <br /> Billing Statement For 1991 Permit; Underground Tank Facility . <br /> Statement Date ; January 7, 1991 <br /> Payment Due irate; February 7, 1941 <br /> I <br /> 1 <br /> Container fee 0001 170.00 <br /> State surcharge 0001 =6.00 <br /> I I <br /> TOTAL FEES DUE 8226.00 <br /> I I <br /> I I <br /> I I <br /> NOTES; <br /> Notify Public Health =services, <br /> San Joaquin County of any <br /> corrections or oanges <br /> necessary. Your permit will <br /> be mailed upon receipt. of I <br /> payment and approval of <br /> facilat.y. <br /> Return payment along with one <br /> copy of this statement to; <br /> I <br /> PUBLIC: HEALTH SERVICES <br /> I SAN JOAQUIN COUNTY I <br /> ENVIRCINME14TAL HEALTH PERMITISERV10ES <br /> P.O. BOX 2009 <br /> I STOCKTON, CA 95201 <br /> I Penalties will be added after I <br /> due date as shown; <br /> I I <br /> Iso days - 100% of base Fee I <br />( I <br />� I <br /> I <br /> I <br />