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SAN JOAQUIN COUNTY , <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR004� 368 <br /> INVOICE <br /> Facility ID FA0023636 <br /> / Date Pri ed 10/31/2018 <br /> DVA RENAL HEALTHCARE INC RE : ANTECA DIA IS <br /> CYNTHIA HUTCHISON/ L&C DEPT 1620 W YOS TE AVE _ I <br /> 5200 VIRGINIA WAY MANTEC A 95337 V <br /> BRENTWOOD, TN 37027 <br /> OWNER : DVA NAL HEALTHCARE INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0314382---Date of Invoice: 9/26/2018 VIII VIII VIII VIII VIII II9/26/2018 1921 HMBP-Regular-Primary Location / $ 347.00 <br /> 9/26/2018 1922 CERS Processing Fee � lee Ck����* <br /> $ 30.00 <br /> 9/26/2018 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> /' / To forthisln $ 426.00 <br /> AM'J�✓ LT/3 if voice Payment Due Date 10/27/2018 <br /> Invoice# IN0317298---Date of Invoice: 10/30/2018 <br /> ZTOT�A�L�DUIE <br /> 10/30/2018 4530 LG QUANITY GENERATOR $ 225.00 <br /> Total forPayment Due Da 11/30/2018 <br /> this Billing Pe od $ 651.00 <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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> i?i}.rpt <br />