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SAN JC AQU N COUNTY <br />ENVIR 6NIVI"ANTAL HEALTH DEPARTM f <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />MICHELLE STEFFLER <br />1755 CREEKSIDE OAKS DR., SUITE 190 <br />SACRAMENTO, CA 95833 <br />• Page 1 <br />Account ID <br />AR0041642 <br />Facility ID <br />FA0022732j <br />Date Printed <br />3/31/2015. <br />RE: METRO -PCS SAC134 <br />16717 W GRANT LINE RD <br />TRACY, CA 95391 <br />OWNER: T -MOBILE WEST CORPORATION <br />Date Health <br />Program Decrriptinn Amount <br />Invoice # IN0263471 --- Date of Invoice : 1 /2 912 01 5 <br />1/29/2015 1921 HMBP-Regular-Primary Location <br />1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />3/15/2015 9987 Haz Mat Program Penalty Fee <br />F"�,S'i DUE! <br />WE: WOULD APr p—;=C!A1'E YOUR <br />PAYMENT TODAY! <br />IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII <br />VIII III <br />$ <br />I IIIIII VIII IIII IIII <br />270.00 <br />$ <br />35.00 <br />$ <br />27.00 <br />Total for this Invoice <br />$ <br />332.00 <br />Payment Due Date <br />2/28/2015 <br />$ <br />332.00 <br />TOTAL DUE this Billing Period <br />D <br />0 <br />Vp15 <br />A <br />j NE�`�jH <br />ENv,,�MMISE��\CES <br />pE <br />Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br />penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br />at the Rate of 100% of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br />30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br />5254.rpt <br />