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t <br /> SAN _:}_it Ay)._J I N LOCAL HEALTH H DiS i RlC:T <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 PAYMENT <br /> Stockton, CA 95201 RECEIVED <br /> (209) 460-342S <br /> Mi Khanna, M.D. , Health Officer FEB 11989 <br /> .ENVIRONMENTAL HEALTH <br /> HAMME77 PERMIT/SERVICES <br /> HAMMER LANE SHELL #4 HAMMER LANE '-SHELL # <br /> - . AlA i•: Its /700 s�,.({l} r.�( �:iii�` i <br /> !i RE.LAND _R <br /> Billing Statement For 1989 Permit, Underground Tank Facility . <br /> Statement Date ja} uary 1 , 1989 <br /> Payment Due Date; February 1 , 1989 <br /> Previous Balance 400.00- <br /> Facility <br /> l.i_} ) 00- <br /> FaCility Fee; 100.00 <br /> Facility Fee: 100.00 <br /> 0001 50.0o <br /> 0001 60.00 <br /> 0002 50.00 <br /> 0002 50.00 <br /> 00 03 50.00 <br /> to 0 3 50.00 <br /> 0005 SO.00 <br /> NOTES* 0005 50.00 <br /> Notify the Salt _oaqui ! Local 0007 50.00 <br /> Health District 4f any 0(}08 50.00 <br /> corrections or changes <br /> , l --------- <br /> necessary . Your j-'tl'"t•.11 l� will <br /> be mailed upon receipt of TOTAL FEES DUE $350.00, <br /> payment and approval of <br /> facility . <br /> Return payment along with one <br /> copy of this statement to: <br /> _SAN jOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> P.O. BOX 20 09 <br /> ST)iCKTON, CA 9S201 <br /> Penalties will be added after <br /> :due date as shown-.- <br /> 30 <br /> h_wn;30 days - IC}_% of Ease Fee <br /> 1 <br />