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SAN,JOAQUIN LOCAL HEAL H DiSTFIC <br /> � ... 15�)1� E. Hazelton Ave. , P.O. Box 2009 <br /> _ Stockton, CA, 96201 <br /> e209) 4332142S <br /> Jogi Khanna, M.D. , Hearth Officer <br /> P A'YJA V 4 D <br /> ` RSG <br /> WORTL i S 1989 <br /> DONALD G. WORTLEY DONALD S. WORTLEY AUG � <br /> %. <br /> LODI, CA 95240 �NVIRONMENTRVICES <br /> PERMIT ISE, <br /> Billing Statement For 1989 Permit, Underground Tank: Facility . <br /> Statement Date August 1 1989 <br /> Payment. Due Date: September 1 , 1989 <br /> Previous Balance 94.00- <br /> Facility Fee: 10.00 <br /> Gnt.ainer Number; 0001 50.00 <br /> TOTAL FEES DUE $55.53 <br /> NOTES: <br /> Not-iii t�n,� Seri josquin Local <br /> - Healhh District of bny <br /> �torreclions or changes <br /> necessary . Your permit will <br /> be mailed upon receipt of <br /> payment and approval of <br /> fahlit.y . <br /> Retur'n .payment along with one <br /> copy of this statement to: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMITISERVICE:= <br /> P-0. BOX 2009 <br /> STOCKTON, CA 95201 <br /> _R'wwjtie5:_.wii1 be added after <br /> due date a srn wn. <br /> 30 days - 100% of Base F,. <br />