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i; on . 'JMYU11 1 VVIII T rV6L11 eCHL IM bCKVif,Cb a9 Urt eDCDD <br /> _ L'. 1RONMENTAL HEALTH DIVIS ON Statwent Printed . 1 /19 /96 <br /> 304 E WEBER AVENUE - 3RD F�DPO �- <br /> PO 2.0' $88 <br /> gI�OCK.TON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> L.: r"s r a :0_ <br /> TO : CHEVRON USA <br /> PO BOX 5004 Account # 0008424 <br /> SAN RAMON , CA 94583 <br /> ATTN : KATHY NORRIS /PERMIT DESK Facility ID 006437 <br /> RE : RONS CHEVRON #90557 <br /> •. '�+4.3r3-_, lJ-7�R�fiT...-.,S..T.OG..K.2D.N..�..,........:_�_.-.._ ____�..�_.—...__:�_._.�.�_ _v4._-'- - - ' <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity �— <br /> Date Description Hrs Employee Amount <br /> Invoice # 034696 -- Date of Invoice : 12/17/96 <br /> 12/17 /96 2360 UST Permit Fee Tank # TA103905 $170 . 00 <br /> 12/17 /96 2360 UST Permit Fee Tank # TA103906 $170 . 00 <br /> 12/17 /96 2360 UST Permit Fee Tank # TA103907 $170. 00 <br /> 12/17/96 2360 UST Permit Fee Tank # TA103908 $170 . 00 <br /> Total for this invoice : $680.00 <br /> Payment DUE DATE 01/18/97 <br /> If this INVOICE has been Paid, Please Disregard this Notice . <br /> (75%05o u v 44 <br /> JAN 3 01997 <br /> SAN JOAOUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMIT Fe at the rate of 10Y of the Service Fee <br /> at the rate of 101% of the Base Fee 30 days after the Payment DUE DATE <br /> 30 days after the Payment DUE DATE. and EACH 30 days thereafter. <br /> TOTAL DUE this Billing Period: <br /> Please Make CHECKS PAYABLE to: F> A0 .".'iii. ,J 1i : N0H:) <br /> $680 . 00 j <br /> 0 to 30 days 31 to 60 days 61 to 90 days 91 to 120 days 120 days Account <br /> Balance <br />