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i = Page 1 <br /> SAN JOAOUIN COUNTY PUBLI ALTH SERVICES <br /> ENVIRONMENTAL HEALTH DION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209465-3420 <br /> INVOICE Account ID AR0017623 <br /> V FA0010623 <br /> Facility ID <br /> Date Printed 211/01 <br /> RE : SAM LUNG LAUNDRY INC <br /> SAM TOY 742 E MAIN ST <br /> SAM LUNG LAUNDRY INC STOCKTON CA 952023120 <br /> 742 E MAIN ST <br /> STOCKTON CA 95202 OWNER: SAM TOY <br /> Health - - - Hrs Employee Amount <br /> Date Program Description <br /> Invoices{ IN0080825--Date of Invoice: 1130101 <br /> $100.00 <br /> 1/3012001 2220 SM HW GEN<5 TONSIYR $10.00 <br /> 1/3011001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE Total forthisInvoice $110.00 <br /> Payment Due Date �1312Q01` <br /> TOTAL DUE this Billing Period $110.00 I <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> FPenalties will be added to all Permit Fees <br /> For all SERVICE FEES <br /> at the Rate a added <br /> %of the Base Fee Penalties will be added at the Rate of 10 <br /> 60 Days after the invoice Date and each 30 thereafter <br /> 30 Days after the Due Date <br /> PAYMENT <br /> RIECENED <br /> MAR 0 0 2001 <br /> :COUNTY <br /> PI,S, r it q�r!CES <br /> 5255.rpt <br />