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SAN JUA(U*OC:AL HEALTH DISTRICT <br /> 1501 E. Hazelton Ave. , P.O. Box, 2009 <br /> Stockton, CA 95101 <br /> (109) 45:3-3425 <br /> Jogi Khanna, M.D. , Health Officer <br /> VANVLI7 <br /> JOHN VAP! VLIET JOHN VAN VLIET <br /> 17182 E. SIEDNER ROAD 17782 E. SIEDNER ROAD <br /> ESCALON, CA . 95320 ESCALON, CA 95320 <br /> Billing St.at.ement. For 1989 Permit, Underground Tank Facility. <br /> Statement Date August. 1, 1989 <br /> Payment. Due Date; September 1 , 1989 <br /> Previous Balance 5£ .00 <br /> Facility Fee: 100.00 <br /> Container Number: 0001 50.00 <br /> TOTAL FEES DUE $205.00 <br /> NOTES: <br /> Notify the Sar, Joaquin Local <br /> Health District of any <br /> corrections or changes - <br /> necessary. Your permit will <br /> be mailed upon receipt of <br /> payment and approval of <br /> facility . <br /> Return payment along with one <br /> copy of this statement too <br /> ':Aid JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT/:SERVICES <br /> P.O. BOY, 2009 <br /> STOC:KTON, CA 95201 <br /> Penalties will be ;tided after <br /> due date as shown: <br /> 30 days - 100% of, Base Fee <br />