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~- <br /> PUBLIC HEALTH SERVICES <br /> SAN jOA&(l{N COUNTY <br /> 445 N � �n Joaquin St P O 8Ox ~ 9 <br /> N . n�m� `' ' ' ' ' <br /> StocktoD, Ca 9�201 <br /> (209) 468-0340 <br />� <br />� <br /> SDCONTAMI <br /> 5DENER812 <br /> Site Informatiom <br /> FALCON ENERGY/J . HO8LITZELL IV FORMER ENERGY PETROLEUM SITE <br /> P.D . BOX 1267 PORT RD. 21 & M <br /> STOCKTON, CA 95201 STOCKTON, CA 95203 <br /> | <br /> � <br /> ' <br /> � <br /> i <br /> ^ � <br /> Services were provided for you by the Environment! Health Division on . <br /> August 27 , 1992 for INSPECTION & REVIEW 7/20 TO 8/27/92 ' <br /> - <br /> ---' <br /> ! <br /> | <br /> Invoice Date : NOVEMBER 15, 1992 TOTAL DUE ; $100 . 70 <br /> i <br /> i <br /> | <br /> 10% Penalty will be added each . <br /> | <br /> 30 days past invoice date . . <br /> / <br /> PLEASE REPORT CHANGES IN THE RETURN PAYMENT ALONG WlTH ONE COPY OF | <br /> SPACE PROVIDED BELOW WITHIN THIS STATEMENT TO : <br /> | <br /> 15 DAYS OF THE DATE OF THIS .. <br /> INVOICE , IF NOTIFICATION IS Public HeAlth Services , San Joaquin � <br /> NOT RECEIVED WITHIN THAT TIME Health <br /> PERIOD, THE PARTY IDENTIFIED P . U . Box 2009, Ca- 95201 ' <br /> ABOVE WILL BE LEGALLY RESPON- '. <br /> SlBLE FOR THIS BILL . � <br /> IF THE ABOVE BILLING ADDRESS IS NOT CORRECT' ~PLEASE INDICATE BELOW, ' <br /> NAME : ----------------------------------------- PHONE #------------------ <br /> / <br /> ADDRESS ; ----------------------------------------------------------------- ! <br /> | <br /> __________________________ ____________ ________________ <br /> ! <br /> CITY STATE ZIP | <br /> ` <br /> ! <br /> | <br /> � <br /> � <br />