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PUBLIC HEALTH SEItICES OP��iN C <br /> SAN JOAQUIN COUNTY r <br /> JOGI KHANNA M.D.,M.P.H. ._ <br /> Health Officer <br /> P.O. Box 2009 • (1601 East Hazelton Avenue) Stockton, California 95201 FoR <br /> (209) 468-3400 <br /> A. Teichert & Son <br /> 3500 American River Dr. ! . <br /> Sacramento, CA. 95813 <br /> TEICH20 <br /> BILLING STATEMENT _ <br /> FOR <br /> UNDERGROUND FUEL STORAGE TANKS <br /> RE: 20913 E. Highway 12 , Clements, CA. <br /> BILLING FOR 1991 PERMIT TO OPERATE AN UNDERGROUND TANK FACILITY: <br /> STATEMENT DATE: February 7, 1991 <br /> DUE DATE: March 7, 1991 <br /> CONTAINER FEES: 0001 $170. 00 <br /> 0002 N/A <br /> STATE SURCHARGE <br /> FEE: 0001 $ 56 . 00 <br /> AMOUNT DUE: $226 . 00 <br /> Penalties will be added after <br /> due date as shown: <br /> 30 days - 100% of Base Fee: <br /> NOTES: <br /> Notify Public Health Services, <br /> San Joaquin County of any <br /> corrections or changes. Your <br /> permit will be mailed upon <br /> receipt of payment and <br /> approval of facility. <br /> Return payment along with one <br /> copy of this statement to: <br /> Public Health Services - <br /> Environmental Health Division <br /> P.O. Box 2009 <br /> Stockton, CA. 95201 <br /> sion of San Joaquin County Health Care Services <br />