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SAN JOW.FIN LOCAL HEALTH. DISTRICt <br /> 16p1 E. Hazelton Ave. , P.O. Bre: 2009 <br /> Stockton, CA '35201 <br /> f,Sort , <br /> t 20 1 468-3425 . T <br /> do9i . Khanna, M.D. , Health Officer <br /> r e.5 4.., r BJJC075, <br /> BJJ CQ. , INC. B.IJ CO. , INC. <br /> <br /> TRACY, CA 95376 <br /> Billing stat.emE-nt. For 1589 Fermat, Underground Tank Faci1it' <br /> 4i <br /> Statement Date JailLlarY 1, i��j � <br /> PaYmeirA--Due [eke Ft�trt+aw T��3i- - <br /> _Faci tYF - - — - - i00 UO- _ - <br /> Container Numbero 0401 SO.uU <br /> TOTAL FEES DUE _ X154 44 <br /> NOTES; <br /> Not-ify the San Joaquin Local, <br /> Health District of any <br /> corrections or changes <br /> necessary. Your permit will <br /> be maiA71-6;bn receipt of <br /> payment and approval 'of <br /> facility . <br /> Return payment along with one <br /> copy of this statement to: <br /> SAN IOAtUIN LOCAL HEALTH Llo1RI f <br /> ENVIRUNMENTAL HEALTH PERMIT/SERVICES <br /> F.U. BOX 2CK19 <br /> STOCKTON, CA 95241 <br /> Penalties will be added after <br /> due date as shown; <br /> 34 days }C1c1% of Base Fee <br /> h <br /> k <br /> 5 4`' <br /> f � , <br />