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SAM JOAQUIN COUNTY PUBLIC Hyj&TH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVI <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account AR0016740 <br /> IMMMMMMMMUnj <br /> Facility FA0009740 <br /> Date Printed5/11/00 <br /> LMOMMUMOMMONNA <br /> JACK TIERNEY RE: KEARNEY-KPF <br /> KEARNEY-KPF 1624 E ALPINE AVE <br /> <br /> OWNER: KEARNEY-NATIONAL INC <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0070349--Date of Invoice: 4/19100 <br /> 4/19/2000 2220 SM HW GEN<5 TONSNR $100.00 <br /> 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Duc Datc 6/10/2000 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to : PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMEH-f <br /> RECEIVED <br /> MY262NO <br /> SAN JOAQUIN.000NTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMFNTALHEALTH DIVISION <br /> 5255.rpt <br />