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rvoLi� nCnLIM DCIfV1l.CJ Report #5255 <br /> El1130WAENTAL HEALTH OIVIP-ION - Stat-ement Printed : 01/23/96 <br /> 3-94 *E'Wr6ER AVENUE - 3RD JOR <br /> PO BOX 388 i <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468 -3420 <br /> 1'. r-a r✓ c> 1. r. <br /> TO : LODI UNIFIED SCHOOL DIST <br /> <br /> - <br /> ATTN : HEALTH PERMITS Facility ILt 003842 <br /> RE : LODI USD-TRANSPORATION* a�s� <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount-? <br /> Invoice 0 025754 -- Date of Invoice : 01/22/96 <br /> 01/22/96 2380 UST Permit Fee Tank # TA196901 $170 . 00 <br /> 01/22/96 2380 UST Permit Fee Tank # TA196902 $170 . 00 <br /> 01/22/96 2380 UST Permit Fee Tank # TA196903 $170 . 00 <br /> 01 /22/96 2380 UST Permit Fee Tank # TA196904 $170 . 00 <br /> --------------- <br /> Total for this invoice : - 680 .00 <br /> Payment DUE DATE 92 <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> PAYMENT <br /> RECEI`U) <br /> u> <br /> F�E'2 6 1996 <br /> SAN JQAQ1)!I.J <br /> PUBLIC HIALTH SERVICES <br /> ENVIRQNMENTAL HEALTH DIVISION <br /> w <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMITS at the rate of 11% of the Service Fee <br /> at the rate of III% of the Base Fee 31 days after the PaymentDATE <br /> 31 days after the Payment DUE' DATE. �Vd EACH 31 days therea r. <br /> TOTAL DUE this, ,diIlling Period: _ ;680.00 <br /> Account 1.-30 Days 31-60 Days 61- 90 Days 91-120 Days 121+ Plus <br /> Summary <br /> 680 . 00 7/� 0 . 00 0 . 00 0 . 00 0 � <br /> /�, <br />