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Page 1 <br /> _ALTH DEPARTMENT <br /> . AVENUE <br /> -A 95205 <br /> ,r9) 468-3420 <br /> INVOICE Account ID AR0016971 <br /> Facility ID FA0009971 <br /> Date Printed 1/29/2015 <br /> NUNES HAY SERVICE INC RE : NUNES HAY SVC INC <br /> PO BOX 94 14967 S UNION RD <br /> MANTECA, CA 95336-1121 MANTECA, CA 95336 <br /> OWNER : ARTHUR T NUNES <br /> Date Health Amount <br /> Proeram Description __ __,. <br /> Invoice# IN0261172—Date ofinvoice: 1129/2015 11111 HE11111111111111111111I1111111111111111111111111111IN <br /> 1129/2015 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 350.00 <br /> Payment Due Date 2/2 812 01 5 <br /> TOTAL DUE this Billing Period $ 350.00 <br /> *4R 20 <br /> :� R.4% 1301 <br /> h�OFp4RM�Nfy <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 />