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0 <br /> PUBLIC HEALTH SERVICES <br /> SANJ OAQ UIN COUNTY <br /> a: <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> C',qCR��P <br /> P.O. Box 2009• (1601 East Hazelton Avenue) • Stockton, California 95201 'F 6 <br /> (209)468-3400 <br /> Gary Burgin <br /> 2810 Richland Ct <br /> Stockton, CA. 95207 <br /> BILLING STATEMENT <br /> FOR <br /> UNDERGROUND STORAGE TANKS <br /> RE: 3032 E. Waterloo Rd. , Stockton <br /> BILLING FOR PERMIT TO OWN AND OPERATE AN UNDERGROUND TANK SITE: <br /> Permit fees for Tank #4 and State surcharge fees for Tank #4 . <br /> STATEMENT DATE: May 1, 1991 <br /> DUE DATE: June 1, 1991 <br /> 1986 1987 <br /> FACILITY FEE: $N/A $ N/A <br /> CONTAINER FEES <br /> TANK # 0001 $ N/A <br /> 0002 N/A <br /> 0003 N/A <br /> 0004 50.00 50.00 <br /> STATE SURCHARGE <br /> FEE: 0001 $N/A <br /> 0002 N/A <br /> 0003 N/A <br /> 0004 56.00 <br /> AMOUNT DUE:$ 156. 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 /> 0 A Division of San Joaquin County Health Care Services <br />