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. PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY Q' 4 <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer P <br /> P.O. Box 2009 (1601 East Hazelton Avenue) •Stockton, California 95201 <br /> c'9LiFoa�'� <br /> (209)468-3400 <br /> Waterloo Food & Fuel <br /> Attn: Musa Abukhdair PAYMENT <br /> 3032 E. Waterloo Rd <br /> Stockton, CA. 95205" RECEIVED <br /> BILLING STATEMENT JUN 0 4 1"" <br /> FOR UNDERGROUND STORAGE TANKS SAN JOAQUIN SERV i_�_ <br /> PUBLIC HEALTH SERv'{ ' <br /> tNViRuNM0TAL MEAi.Z N <br /> RE: 3032 E. Waterloo Rd. , Stockton <br /> BILLING FOR PERMIT TO OWN AND OPERATE AN UNDERGROUND TANK SITE: <br /> (1991 fees for Tank #4 and State Surcharge fees for Tanks 1-4) <br /> STATEMENT DATE: May 1, 1991 <br /> DUE DATE: June 1, 1991 <br /> 1991 <br /> FACILITY FEE: $N/A <br /> CONTAINER FEES <br /> TANK # 0001 $ N/A <br /> 0002 N/A <br /> 0003 N/A <br /> 0004 170.00 <br /> STATE SURCHARGE <br /> FEE: 0001 $56.00 <br /> 0002 56.00 <br /> 0003 56.00 <br /> 0004 56. 00 <br /> AMOUNT DUE: $394.00 <br /> Penalties will be added after <br /> due date as shown: <br /> 30 days - 100% of Base Fee: <br /> NOTES: <br /> Notify Public Health Services, <br /> San Joaquin County of any <br /> corrections or changes. Your <br /> permit will be mailed upon <br /> receipt of payment and <br /> approval of facility. <br /> Return payment along with one <br /> copy of this statement to: <br /> Public Health Services - <br /> Environmental Health Division <br /> P.O. Box 2009 <br /> Stockton, CA. 95201 ugst.fil <br /> (209) 468-3427 <br /> 6 A Division of San Joaquin County Health Care Services <br />