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PUBLIC HE111H SERVICES, SAN JOAQU i N COUNT-10 <br /> 445 N. San Joaquin 'street (NOT A MAILING AOORESa) <br /> P.O. Box 2009 <br /> Stockton, CA '5201 <br /> (209) 46e-3427 <br /> Jogi Khanna, M.D., Health Officer _. <br /> ON I ON41 <br /> UNCI=CAL UNION OIL SS #6071 - <br /> 175 N. CALIFORNIA BLVD #650 4170 E. WATERLOO RD. <br /> WALNUT CREEK, CA 9096 L TOC KTON, CA 9 5 2 0 S <br /> Billing Statement For 1991 Permit, Underground Tank Facility. <br /> Statement Dave January 7, 1991 <br /> Payment Due Date; February I, 1991 <br /> Container fee 0000 170.00 <br /> State surcharge 0001 56.00 <br /> Container tee 0002 170.00 <br /> State surcharge 0002 56.00 <br /> Container tee 0003 170.00 <br /> `:state surcharge 0003 S6.00 <br /> TOTAL FEES Q,_#E $675.00 <br /> Notify Public Health Services, <br /> San oa,quin aunty of any <br /> PAYMENT <br /> corrections or ct"iaa�ge5 <br /> necessary . '{��ur permit 'gill SAN 22 { �, ���'��� <br /> be mailed up=on receipt. of I�J RE +ry 0D <br /> Fraymeisc� and approval o 9A VP � , � G. 6 '� <br /> cil <br /> facility. <br /> �' �`F�'� <br /> SAP6IQA�, <br /> pLli3t-� ,HES'`4 EALTIt L1Vi5'QP•� <br /> Return pa'yment alone with one �5.1V1R©�yM�f�YA�H <br /> copy of this statement to: <br /> PUBLIC ±SEALTH SERVICE'S, <br /> :3AN Jt3FiQUIN COUNTY APPROVED <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> P.Q. BOX 2009 <br /> STOCKTON, CA 95201 <br /> Penalties will be added after <br /> due date as show l <br /> 30 Shays - 100Y of Base Fee , .� _ 3 .,- , nr•,_1n __ �I�/_�_�---- - _....1 �C ����L <br />