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PUBLI1 HEALTH0. <br /> o • ooT Pa.q'N <br /> SAN JOAQGIN COUNTY Ion . 0 O+ A ' <br /> JOG[KHANNA NCD.M.P <br /> Health Officer- <br /> c0 <br /> fficer 0 . 00+ <br /> c <br /> P.O. Box 2009 • (1601 East Hazelton Avenue) i '0 - 00+ <br /> (209) 468-3400 1 _ c 50 - 00+ <br /> PUBLIC HEALTH SE 2JG OOS <br /> ENVIRONMENTAL HEALT170 . Of+ <br /> 445 N. SAN JOAQUIN (P. 17f' • 0C+ <br /> STOCKTON, CA. 170 . 0( + <br /> (209) 468-3 56 . 00+ <br /> Ernest Brown 56 . 00+ <br /> P.O. Box 323 1 56 . 00+ <br /> Clements, CA. 95227 T0.1 928 • [[[/// <br /> BROWN25 <br /> FACILITY LOCATION: 25290 McIntire, <br /> Billing for 1986 thru 1991 fees =ate an <br /> Underground Storage Tank Facility. <br /> Statement Date: August 8, 1991 <br /> Payment Due Date: September 8, 1991 <br /> 1986 1987 1988 1989 1990 1991 <br /> Facility Fees: $100. 00 100. 00 100. 00 100. 00 100. 00 N/A <br /> Container Fees: <br /> Tank 0001 $50. 00 50. 00 50. 00 50. 00 50. 00 170 . 00 <br /> Tank 0002 50. 00 50. 00 50. 00 50. 00 50. 00 170 . 00 <br /> Tank 0003 50. 00 50. 00 50. 00 50. 00 50. 00 170 . 00 <br /> State Surcharge <br /> Fee: Tank 0001 56. 00 56 . 00 <br /> Tank 0002 56. 00 56. 00 <br /> Tank 0003 56. 00 56. 00 <br /> TOTAL AMOUNT OF FEES DUE:$ 2, 096. 00 <br /> If you have any changes <br /> or corrections please <br /> call our office when <br /> statement is received <br /> at (209) 468-3427. <br /> Penalty's will be added <br /> after the due date shown. <br /> 30-days at 100%of base fee <br /> Please remit one copy of <br /> this statement with <br /> your payment to: <br /> Public Health Services <br /> Environmental Health Division <br /> P.O. Box 2009 <br /> Stockton, CA. 95201 <br /> A Division of San Joaquin Counn•HcALh(are"ims C <br />