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PUFLIC HEALTH cER'VICES, SAN <br /> . ^ , 1601 E. Haieltcm Ave., F O.. Box 2009 <br /> . Ston-k ton, CA 35101 <br /> x2091 ab3-u 5 i. <br /> s ' <br /> jug Khailra, ry D Health Officer <br /> ti `' `b pp yM <br /> GOLF LA <br /> 7650 N.' i <br /> NEST LANE IF LANG �Nj <br /> $5D N. NEST LANE <br /> :ST'iT61 FON, CA .7.1 10 n /.f N <br /> STOC CA 95210 pUi 1V /oA J r� <br /> fNVIRpN IC <br /> y���l'�S N`GI <br /> Billr,w tet.ruent For 1'yU Ferriy�t, l+rwderyrcand Tank Facility. MfN H, JtV <br /> NE'pt jRi:�ts <br /> Statement Date Januar; 2, 19 VISypN <br /> ?ay ent Due Date: February t2, 19x0 <br /> rr'aclilt'y Fee; i(li1.,w <br /> trint..ilrier Number; tj11(?1 50.00 <br /> ?OTAL FEES DUE Sc'i (; <br /> NOTES: <br /> Notify Public Health :er'vices, <br /> San Joaquin �,[:i)rity Q- any . <br /> correct.ior <br /> .s or char <br /> �3es <br /> r:ecessary. .Tour Fermit will <br /> t* mailed upon receipt of. --- - <br /> Payment.t <br /> Y a <br /> nd aFFrrrai ��,-f <br /> facility. <br /> Return Fayo,ent along witF, ,.re <br /> CCwY of ibis statefifent to; <br /> PUBLIC HEALTH SERVICES <br /> SAN JCAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> P.O. BOX 2009 <br /> STOCKTON, CA _3r3zl <br /> F'ewitit will added after f-) <br /> due date as stmwn: o �`'� <br /> VCt days. - 100% of Base Fee - <br /> / r <br />