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PUBLIC HEALTH SERtICES POS N <br /> SAN JOAQUIN COUNTY r' Z <br /> P.' y <br /> N: <br /> JOGI KFiANNA M.D.,M.P.H. s <br /> Health Officer <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) Stockton, California 95201 541 <br /> (209) 468-3400 <br /> A. Teichert & Son �1r�7 <br /> 3500 American River Dr. <br /> Sacramento, CA. 95813 � J <br /> TEICH20 C <br /> BILLING STATEMENT <br /> UNDERGROUND FUEL STORAGE TANKS <br /> Facility Location: 20913 E. Highway 12 , Clements, CA. <br /> Billing for 1986-1990 fees for permit to operate an Underground <br /> Tank site. <br /> Statement Date: February 7, 1991 <br /> Payment Due Date: March 7, 1991 <br /> Facility Fees: 1986 1987 1988 1989 1990 <br /> $100. 00 100. 00 100. 00 100 . 00 100 . 00 <br /> Container Fees: <br /> Tank 0001 50. 00 50. 00 50 . 00 50. 00 50. 00 <br /> Tank 0002 N/A <br /> Tank 0003 N/A <br /> State Surcharge <br /> Fee: Tank 0001 56 . 00 <br /> Tank 0002 N/A <br /> TOTAL AMOUNT DUE: <br /> $ 806 . 00 <br /> If you have any changes or corrections please <br /> call our office when statement is received, at <br /> (209) 468-3427 . <br /> Penalty' s will be added after 30-days at <br /> 100% of base fee. <br /> Please remit along with payment one copy of this <br /> statement to: <br /> PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIV. <br /> P.O. BOX 2009 <br /> STOCKTON, CA. 95201 <br /> A•ion of San Joaquin County Health Care Services <br />