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OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 E. WEBER AVENUE <br /> STOCKTON, CA 95202 <br /> Payment Due Date: November 10, 1997 Total Amount Due: $255.00 Account No.: 6883 <br /> Site Address: C&SONE HOUR MARTINIIZINNG <br /> 5756 PACIFIC AVE#1 - <br /> STOCKTON,CA 95207 <br /> BRF-06 - y OI�7 <br /> Revision1997 7/96 <br /> D E RECEIPT ID NUMBER BUSINESS NAME \_2 ASH CHECK OTHER AMOUNT <br /> NUMBER PMT PMT RECEIVED <br /> RECEIPT No. 20298 <br /> SAN JOAQUIN COUNTY <br /> OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS DIVISION <br /> 222 E. WEBER AVE. — ROOM 610 <br /> STOCKTON, CA 95202 <br /> BY <br /> CASHIER <br /> to SENDER- <br /> 11 •Complete items 1 an, for additional services. I al£ 'sh to receive the <br /> 're -Complete items 3,4a. 4b. foliod services(for an <br /> is •Prim your name and address on the reverse of this form so that we can return this extra fee): <br /> card to you. <br /> •Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 'Z <br /> permit. d <br /> y •Write'Retum Receipt RaCluested'on the mailpiece below the article number. 2. 1:1 Restricted Delivery y <br /> •The Return Receipt will show to whom the article was delivered and the date <br /> delivered. Consult postmaster for fee. .� <br /> 3.Article Addressed to: 4�clm <br /> a 6883 ' 4b.Service Type w <br /> o C&S ONE HOUR NIZING <br /> O ATTN PATEL Ct S B ❑ Registered CeRlfied Cl <br /> N 5756 PACIFIC STS: ❑ Express Mai El Insured 5 <br /> W STOCKTON CA 95"x..07 f4 <br /> c ❑ Return Receipt?or Merchandise ❑ COD <br /> 0 7.Date ot&wry °^ <br /> a <br /> z CIC > <br /> 5.Received 8y: (Print Name) 8.Addressee's Address(Only if requested <br /> Lu and fee is paid) t <br /> H- <br /> 6.Signature:(Addressee or Agent) <br /> r X G <br /> PS Form 3811, December 1994 Domestic Return Receipt <br />