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d• <br /> LOCAL HEALTH DISTRICT <br /> Stockton, 6A 95201 <br /> (209) 468-02S <br /> josi Khanna, M,D, , Health Officer <br /> POMS024 <br /> R`1L'._r POW-1 ERNEST POMBO <br /> PQ. PDX SOS 24100 S. LAMMERS ROAD <br /> TRACY, CA . 95376 TRACY, CA 9S37G <br /> 1 :. 109 Statement ;For 1989 Permit, Ltilde•1"'-!1'1»iund Tank Facility . <br /> Statement(t- Li at`a Lit..iguct 1 , 1989 <br /> Pc1yment. Due Wei SwpCaii€l.l`_'S' is 1989 . <br /> Previous Balance 112.00 <br /> Hard+x•4' e_ : 100 W-: <br /> - x <br /> l•_If!i-dif€t.'r Number; '•.Iti{01 ��;_ i4.i <br /> 00 <br /> TOTAL FEE_ DUE $312.00 <br /> f�'-,�;. <br /> i w r <br /> Notify the San joaquin Local <br /> Health District of any <br /> correc1ions. or change,--, <br /> necessary . Your permit will <br /> be sailed t!pti+n receipt of . <br /> payment and approval of <br /> Return payment along with one <br /> copy of this statement to: <br /> ,'4', -' +! � ���5•=L ='i,. 14 ri �.� 3 r� �• <br /> ENVIRONMENTAL HEALTH . E1'.i iTY.=cLRr:1i.E—: <br /> P0. BOX 2009 <br /> STOCKTON, CA 95201 <br /> � <br /> Penalties 1r3iii be aul.��=-- <br /> � itt-Nt' <br />