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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH <br /> 445 N San Joaquin St., P.O. Box 2009 <br /> Stockton, Ca 95201 <br /> (209) 468-3447 <br /> October 19, 1992 <br /> BILLING STATEMENT <br /> SITE INFORMATION: <br /> .FRED CLARK ACCEN74 <br /> . <br /> STOCKTON, CA 95205 <br /> Billing for Back fees for Permit to own and/or operate an Underground Storage Tank Facility. <br /> Statement Date: October 19, 1992 <br /> Payment Due Date: UPON RECEIPT <br /> TOTAL FEES DUE $'4--n2= AY4" <br /> 1986 1987 1988 1989 1990 1991 1992 <br /> Facility Fee 100 100 100 100 100 na na <br /> Container Fees 50 50 50 50 50 170 170 <br /> PENALTY na na 150 150 150 1.70 170 <br /> State Surcharge *6 11 i '11zg'L C5.6 <br /> SUB TOTAL DUE: 206 150 300 300 300 396 340 <br /> Please remit one copy of this If you have any questions <br /> statement with your payment to: regarding this statement, <br /> Public Health Services you can contact the <br /> Environmental Health Division accounting office at <br /> PO Box 2009 (209)468-3447 <br /> Stockton, Ca 95201 <br /> PENALTIES HAVE BEEN ADDED AFTER DUE DATE AS SHOWN: <br /> 30 DAYS - 100% OF BASE FEE <br /> y� <br /> v <br />