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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH 74': Y T <br /> 445 N San Joaquin St., P.O. Box 2009 <br /> Stockton, Ca 95201 � g <br /> (209) 468-3447 AUG 12 <br /> SAN JG4Q-106 C <br /> July 13, 1992 <br /> ENVIPONMEN <br /> BILLING STATEMENT <br /> SITE INFORMATION: <br /> .JOHN ELSUMERI RIPON22 <br /> .223 WASHINGTON RIPONA MARKET <br /> .RIPON, CA 95366 223 WASHINGTON <br /> RIPON, CA 95366 <br /> Q:I :...-. <br /> for Back i...-..- for Per and/or Underground Gam__•-__. T� i r_ .l. <br /> ui Back i�oa Zvi i c,�l'+iit �O il'vJri anuiuc vNcPdtc iaii .S wiG�JC �dlill facility. <br /> Statement Date: July 13, 1992 <br /> Payment Due Date: UPON REIPT <br /> TOTAL FEES DUE 3184 <br /> 1986 1987 1988 1989 1990 1991 1992 <br /> Facility Fee 100 100 100 100 100 NA NA <br /> Container Fees <br /> Tank #1 50 50 50 50 50 170 170 <br /> Tank #2 50 50 50 50 50 170 170 <br /> PENALTY NA NA 200 200 200 340 340 <br /> State Surcharge 112 112 <br /> SUB TOTAL DUE: 312 200 400 400 400 792 680 <br /> Please remit one copy of this If you have any questions <br /> statement with your payment to: regarding this statement, <br /> Public Health Services you can contact the <br /> Environmental Health Division accounting office at <br /> PO Box 2009 (209)468-3447 <br /> Stockton, Ca 95201 <br /> PENALTIES WILL BE ADDED AFTER DUE DATE AS SHOWN: <br /> 30 DAYS - 100% OF BASE FEE <br />