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Y , <br /> 117JAIIIIL01AL HEAL t H DISTRIC:1 <br /> ge l ton Ave. , P.O. Eo ' 2009 <br /> Stakton, CA 9 2ol <br /> (209) 468-3425 . <br /> Jori Khannh, M.D. , Health Officer <br /> a <br /> E-Z SERVE, INC. EZF 02'G �a7o3d <br /> F'. CE. BOX E ;5Ci 2537 WA T ERLCEC 'RD. <br /> ONTARIO CN 91761 STOCKTE:N,. CA `:-520S <br /> Bi l l ik Statement For 1988 Permit, Underground Tank Facilit.y . <br /> Statement. Date r January is, 1908 <br /> �i �€t• �� �° ��CRtP ��''L�4 111 <br /> F'a €€e wry_. IRS <br /> Facility Fee! 100.00 <br /> Container Number; 0001 50.00 <br /> 0002 So.100 <br /> 0OC13 50.00 <br /> TOTAL FEES DUE $250,00 <br /> NOTES: <br /> Notify the San Joaquin Loc aI <br /> Health District of any <br /> corrections car changes <br /> necessary , Your permit will <br /> be mailed upon receipt of <br /> pays€lent aid approval of <br /> facility. <br /> Return payment. along with one <br /> copy of- this statement to: - <br /> SAN JCEAl,UIN LOCAL HEALTH DISTRICT T <br /> EI VTRI-INMENTAL.HEALTH PERM!T1'3F.:v'ICES <br /> P.O. BOX 2009 <br /> S T€_iCKT=_iia, CA 9201 <br /> F'ena l t.i es 'will be added after <br /> roue date as shco, n; r <br /> 0 gays - 100 of Base Fee <br />