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M&K <br /> P.O. BOX &K* <br /> THORNTON, CO. -3 b U3 <br /> 1. <br /> lilling Stalefflent 7 cw i perf it <br /> Statement Date J; 9 <br /> Payment Due Date. <br /> Etc <br /> i c 7 <br /> -------- <br /> TjIAL 1-i' L' 7 <br /> 10TES: <br /> Notify the �_.an Joaquin i oc k I <br /> Health District. of <br /> corrections or chanqes <br /> necessary . Your 'Parriat woill <br /> be maileo upon receipt co <br /> Payfftent and approvai of <br /> facility . <br /> Return Payment alOng .4 -h cene <br /> copy of this staterfiert+ to <br /> SAN 3OAQVIN LCIt..AlL. H '.L-I-H, U i6 IR'l C <br /> ENVIRONNFWAL HEA1 H PERMIT/SEF:` <br /> P.O. BOX "009 <br /> SIOCKTON, ul 'x+:'1101 <br /> Penalties w i I , oe added of ip v <br /> due date as '"i how is <br /> -'0 Clays - i6-' of Base Fee <br />