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�.!S; TC� <br /> r ;ERiN&AN jOAQUiN COIJINIT11 <br /> 1601 E. Hazelton. 40e.l P.O. Sox 204x3 <br /> St <br /> CA '9,8201 <br /> jnaI vapm' M.D. Real ttl Officer <br /> UV'115iO. 3WT-N HARK"R *7111KEY SLU-11164 <br /> P. J. BOX 07 Ra. <br /> HILT, CA 95234 <br /> R-1 Pa '-'tateffleilt For Mt, Piimit, URderg.c.-tur-4 Tadk FAcil;ty. <br /> taj� ent Date : 'Talluary 2, 1331) <br /> rament We Date: Feb-um 2, 1530 <br /> Facility FFee, 1010.00 <br /> Container %illber: C4,101 60.00 <br /> (02 56.00 <br /> TOTAL FEES DUE $200.00 <br /> MOTES; <br /> Wt fy PlIlic Health Smices, <br /> Gan Joaquin County of any <br /> corrections Cr changes <br /> Ncmary. Your permit will <br /> to .veiled U"rjn receipt of <br /> payment and Iapproval of <br /> fad iity. <br /> Returis payment along with om <br /> covey of this statement 0: <br /> NI'BLIC HEALTH SERVICESSAN jc�Qu-Ami cary <br /> MILPTNIMEsWAL HEALTH PER11IT/C—I'MCCES <br /> P.O. BOX 2009' <br /> Sw ON, c-A 95261 <br /> Penalties AD tie added after <br /> dila date as shown; <br /> days - 100% of Basse Fee <br />