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pwigbNMENTAL HEALTH DIVISION° / <br /> 304 E W QRER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209468-3420 <br /> `i <br /> —a <br /> INVOICE Account I AR0020236 <br /> Facility 14 FA0012382 <br /> Date Printed 4/25/00 <br /> DAVID CARAVCO RE: AMERICAN MEDICAL RESPONSE <br /> AMERICAN MEDICAL RESPONSE 247 CHRTER WY <br /> 7575 S FRONT RD <br /> LIVERMORE CA 94550 <br /> OWNER: AMERICAN MEDICAL RESPONSE <br /> Health <br /> Date pro ram Description Hrs Employee Amount <br /> Invoice# IN0071546—Date of Invoice: 4/191 <br /> 4/19/2000 2220 SM HW GEN<5 TONSNR $100.00 <br /> 4/1912000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 5/25/2000 <br /> TOTAL DUE this Billing Period <br /> $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 al SERVICE FEES <br /> at the Rate of 100%ofthe 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 eafi 30 thereafter <br /> MW25M <br /> SAN JOAQUIN Cu,,i r <br /> PUBLIC HEALTH SERVICES <br /> ENVMNI°IFNTAI.HEALTH DIVISON <br /> 3255.rpt <br />