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PUaL}C HEALTH SERVICES, SAN | <br /> JOAQUlNCUUNTY . <br /> 445 N. ban JoaquinStree'L (NOT AMAILING ADDRESS) <br /> P.O. Box 2009 <br /> Stockton, CA 96201 ' <br /> (209) 468-,W7 / <br /> | <br /> �oSl. Khanna/ M.D. ' Health 8ffifer / <br /> / <br /> | <br /> R�EAU31 / <br /> <br /> <br /> <br /> 8[0CKTUN/ CA 95206 ' <br /> \ <br /> 6il\ing Stat�men� Fnr 1991 Perm11 / Underground |ank Faczlity . ' <br /> | <br /> Statement Date }anuary // t99| / <br /> Payment Due Date, February 7, 19':i1 | <br /> | <br /> S�� �rc�r� ��1 � O0 i <br /> Container fee O001 l/S00 i <br /> -^---.-_^ \ <br />, TOTAL FEES DUE $226.00 | <br /> | <br /> | <br />| | <br />/ . <br /> | <br />/ . <br />| NOTES | <br /> | <br />! <br /> Notify Public Health �ervice�' <br /> / <br />/ \ <br />/ 36n JoaquinCounty nf any ' <br /> corrections or chanDes | <br />| necessary , Your Permit will | <br /> be mailed upon receipt o, | <br />| <br /> Payment and approval of <br /> facility , <br />' <br /> Return payment alon8 with one <br /> ' <br />| | <br />/ cnpY of this statement tui ' <br />| / <br />/ Pi&BLIC HEALTH SERVICES � <br /> SAN JUAAUlN COUNTY � <br /> ENVIRONMENTAL HEALlH FERMI T/SEKVlCES | <br />| P.O. BOX 2009 | <br />| Sll)� 9 <br /> KT0N, CA b201 | <br />/ . <br />| | <br />/ Penalties will be added after <br />| ` <br /> due date as shown: <br />| | <br />! <br />/ 30 days - 100% of Base Fee <br />. ^ <br />| | <br />/ . <br />| | <br />/ . <br />| | <br />\ | <br /> | <br />| ' | <br /> | <br />