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f" <br />' <br />P1Eit..IC "]H SERVICES <br />'A JOWN WTY <br />_ <br />01 . Hazelton Ave., P.O. Bax 2(165 <br />Stockton, CA 35.201 <br />t 1 <br />i -i) 458-3447 <br />Jao3i'Marma, O.D., Wealth Of firer <br />{ <br />PAWE ;TE <br /> <br /> <br /> <br /> <br /> <br /> -JON. CA 35.M <br />Sil.lirtg Stisteffient <br />for Ser -'ice Period evridinq; Deceorier 31, 195+.1 <br />Env:ron?rtai tLh <br />Peas''+ to be issue, for : )= 5 TONS t 25 4A` 41 <br />(`HAZAMM 'WASTE 6E EBATOR)Statersent <br />Gate; <br />�ember 1, 195'3 <br />Due Date; <br />c car 1 69 <br />i <br />VAL OVE, .1-21.15 <br />Penalties will be <br />dei of er Notify L,w-e Environmental 1*alth <br />due date a5 sitc , <br />Divisicirc of ariy corrections o <br />charr3e5 necessary. Permit joill to <br />30 &ys -101 <br />f Base F mailed LW11 receipt ctf pay n1,. <br />Return payment alor3 with one copy <br />of "4115 statmerit to" <br />Public Fleal-th Services, Sart Joaquin <br />CourltyiEwirowntal Healtf, <br />i <br />P. 0. Box 2009, 'Stockton, CA 9-201 <br />j <br />t.tl.zr'JWYL F?�.th=�—i• <br />Vii?F—� 9y.i Yi Yet I•�OiM�1M fhi i•r_ H•i _ —�. �' "�-1 L4 + - - <br />