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SAN .10AQUIN LOCAL HEALTH DI'S'TRICT <br /> 1601 E. Hazel ton Ave. , P.O. 2ox 2009 <br /> 4�-:;tockton, CA 95201 <br /> (209) 463-344S <br /> J cig A Kh;�nna, M.D. , Hea ith Officer <br /> FHCON49 <br /> ST <br /> F b H CONSMUCTIC-IN F & H C13N [RUC--TION <br /> 4,34-S WATERLOO RD. 4946 WAIERL.00 RD. <br /> STOCKTON, CA 95205 t---,'TOCKTON, CA 9520S <br /> Billing Statement For Fermi t•, U-nderground lank Facility. <br /> Staternerit Date ; January I.S, 1988, <br /> Payment Due Date! February 15, <br /> Facility Fee: <br /> Container Number: 0001 so.o() <br /> (10 0 11 50.00 <br /> 00o.3 00 <br /> ---------- <br /> TOTAL FEES DUE $250.00 <br /> NOTES, <br /> Notify the Joaquin Local <br /> Health District.. of any <br /> coi,rections or changes <br /> necessary . Your permit will <br /> be mailed upor, rect;-:10. of <br /> payment- 'and approval <br /> f cac i 1 i ty . o <br /> Return payment. along with one <br /> copy cif this statement' to; <br /> C'AN JCIA(�Uliq LOCAL. HEALTH DISTRICT <br /> S ' r. <br /> ENVIRONMENTAL HEALTH PERMUT/SEERVICES <br /> P,0. BOX 2,009 <br /> STOCKTON, CA 95201 <br /> Penalties will be added after <br /> due date as shown: <br /> 30 days - 100% Qi Base 'Fee <br />