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• Ol n �'�' "' - <br /> :,AN jOAQ`U1d LOCAL HEALTH D1cTfi1C:1 PAYMENT <br /> 1:,-01 E. 'Hazelton Ave. , P.ci. grn: RECEIVED <br /> t._,cktcoi„,C:A , 5200 , <br /> FEB 1 <br /> dbti-:jn�� <br /> Ic i' Khanna,"M.D. , Health Officer <br /> .ENVIRONMENTAL HEALTH <br /> CAL TRANS CALTRBd PERMIT/SERVICES <br /> 845 E. PINE STREET CAL TRANS - 1.001 NADNTENANCE <br /> LODI, CA 95240 845 E. PINE ;,1:....,.._. _ _..� <br /> LOD I, CA 95240 <br /> Eii11'ing St.n}ernent:'"Fbr "i = �..Jt Undergi�Gund Tank Facility <br /> Statement Date January <br /> PaYmc:,t. Due Date; February <br /> Facility FEE,: <br /> CGntainer Number: 000f <br /> W.W.Q00002 SO 00 <br /> Q` <br /> TOTAL r r 011E $2_ <br /> 06.00 <br /> Notify the Safi JOayuili Local <br /> He rDist:ri:t of c'nyCOT , <br /> nee i'eC t.I"6415. r cl7anyes - - - <br /> necessary. Your permit. <br /> ui11 <br /> be mailed upon receipt of <br /> Payment and approval of <br /> - <br /> Ret.urn' pay'fnent also, with one <br /> this of <br /> c6PY h <br /> . i5 stat et:elft tn; <br /> Ajv :iOAQVIN LOCAL HEALTH 0I'S RICT �+ <br /> ENVIRONMENTAL HEALTH PEFNIT/SEP,VICE$ <br /> F'.0. BOX 2009 d <br /> STOCKTON, ,CA 95201vihr <br /> Peralt.ies will be added after <br /> due date as shown; <br /> i <br /> J_ <br /> :;C; u ys - 1 )ox, of Base Fee <br /> W <br />