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r <br /> { <br /> _ . , R'' <br /> SAN JUAr�tU1N �UC:F1L HEALTH DIS <br /> Init'f <br /> 1601 E. Hazelton Ave. , P.O. box 2009 <br /> Stockton, CA 96201. <br /> (209) "458-342S <br /> Jogi Khania, M.D. , Health Officer <br /> USAPE2i I <br /> MARK CONANT USA PETROLEUM COMPANY #110 <br /> P. 0. BOX 18 39 2132 MARIPOSA RD <br /> ;NTA MONICA, CA 90406 STOCKTON, CA 95206 <br /> " - ,.. Underground Tank Facility. <br /> liliiii3 .c;t.n�.ernent. For 1'_'�i� larrni �., <br /> r <br /> Statement Date :ianuary 1;. 1989 <br /> Payri,ent. Clue Date; February 1, 1'+C <br /> Facility Fee, 100.00 <br /> C:Oiit.ainer Number; 0001 50.00 <br /> 0002 5O.v0 <br /> 0003 a).00 <br /> 0004 50.00 <br /> TOTAL FEES DUE --$300.00 <br /> TOTES <br /> Notify the 'van Joaquin Local <br /> Health District of ally <br /> cc+rrecti.ons of 'changes <br /> necessary . your pet'rftit. will <br /> be mailed upin receipt of <br /> payment and approvaF of <br /> facility . <br /> Return paymelit. along with One <br /> copy of this statement to: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMITISERUICES <br /> P.O. BOX 20(',9 . <br /> STOCKTON. CA 95201 <br /> Penalties will be added after <br /> due date as shown; <br /> iii days - 100% Of Base Fee <br />