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PUBLIC HEALTH SERVICES ,oPQ�,N <br /> SAN JOAQUIN COUNTY <br /> i <br /> a: <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> 6 'r <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) . Stockton, California 95201 °c'r•oaw <br /> (209) 468-3400 <br /> John Vander Schaaf COPY <br /> 777 Schaefer Ave. <br /> Ontario, CA. 91761 <br /> COMP# SMITHI5 NUMBER OF ACTIVE TANKS AT SITE: 1 <br /> BILLING STATEMENT <br /> UNDERGROUND STORAGE TANKS <br /> FACILITY LOCATION: 15751 S. VAN ALLEN RD. , ESCALON. <br /> ON JULY 2 , 1990 THE ABOVE LOCATION WAS BILLED FOR AN UNDERGROUND <br /> TANK FACILITY. THIS FEE IS FOR YOUR REQUIRED PERMIT TO OPERATE FOR <br /> THE PERIOD JULY 2 , 1990 THRU DECEMBER 21, 1990. <br /> PENALTIES WERE ADDED TO THE RATE OF 100% OF THE PAST DUE AMOUNT AS <br /> OF SEPTEMBER 2 , 1990 . THE AMOUNT NOW DUE AND PAYABLE IS $150 . 00. <br /> IF PAYMENT HAS BEEN SENT, PLEASE DISREGARD THIS NOTICE. SHOULD YOU <br /> HAVE ANY QUESTIONS PLEASE CONTACT THE ENVIRONMENTAL HEALTH DIVISION <br /> BETWEEN 8: 00 A.M. AND 4 : 30 P.M. AT (209) 468 — 3427 . <br /> NOTIFY PUBLIC HEALTH SERVICES, <br /> ENVIRONMENTAL HEALTH DIVISION <br /> OF ANY CHANGES IN OWNERSHIP <br /> OR BILLING. YOUR PERMIT WILL BE <br /> MAILED UPON RECEIPT OF PAYMENT AND <br /> UPON APPROVAL OF FACILITY. <br /> RETURN PAYMENT ALONG WITH ONE COPY <br /> OF THIS INVOICE TO INSURE PROPER <br /> CREDIT. <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> A Division of San Joaquin County Health Care Services <br />