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` Plt6iIC HEALTH SEt,,.,5 01 JOW11N COUNTY # • ` <br /> 1601 E. Hazelton Ave., P.O. Box 2009 <br /> Stockton, 'CA 95201 <br /> (2091 d68-WJS <br /> u<}gi 0anna, M.O., Health Officer <br /> TOCIi66 RE YANENT <br /> <br /> <br /> STOCKTON, CA 95207pUQ N JOgQjj(rJ <br /> ENVIRONMEN AL H AS R CES <br /> Billing Statetient. For Tank Facility. <br /> -- - _ <br /> '-,t?!etent tYd%e ..3enuaTv 3;-194p <br /> Payment Due Oate, February 2, 1930 <br /> Y <br /> Facility Fee; 100.Uk <br /> g• <br /> Container Number: 0001 50.0t? <br /> TOTAL FEES OVE (150.00 <br /> i <br /> NOTES: <br /> t47jt?fr put.lt[ Healtt) 'derv�ces, <br /> San .�6*in County of any <br /> R corrections or changes <br /> necessary. Your permit will <br /> be �ii�� d Ripon receipt of <br /> paw�rit^'and approval-of <br /> facility- <br /> ( Rel i payment along with one <br /> CWzY•>zb this statement to; <br /> PUBLW HEALTH SERVICES <br /> _�+t JUIN Com-ly <br /> ENIIIRRRONMENTAL HEALIH PETWUSERVICES <br /> = P.&-Ky. 2c109 <br /> STON, CA 95201 <br /> .Perial ti es will be added after <br /> 5Lk-- uie ns shcoan: <br /> 30 days -ju% of Base Fee _ <br /> .s <br />