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REMITTANCE ADVICE VENDER- ID PG 1 STATE OF CALIFORNIA <br /> S OA OU'OTE ENCLOSED WAAAANT IS IN PAYMENT OF INVOI�AS SHOWN BELOW, <br /> STD.ADAC(REV.X11081 DEPT.NO. RP <br /> DEPARTMENT' INVOICE DATE INVOICE NUMBER <br /> INVOICE AMOUNT IND <br /> 0 01f23f96 0003403 <br /> CLAIM SCMED.NO. 340 - 00 <br /> DEPARTMENT ADDRESS 0 <br /> P .O. BOX 269101 9543ZB5 01/Z3;96 0003226510 . 00 <br /> SACRAMEN <br /> 95 26- 91 1 <br /> e A <br /> F—SAN JOAQUIN COUNTY <br /> VENDOR. PUBLIC HEALTH DIVISION <br /> P .O .BOX 388 <br /> 445 N. SAN JOAQUIN <br /> STOCKTON CA 95201-0388 <br /> Rp TYPE TOTAL DEPORTED TO IPS(BEE RMS) TOTAL 850 . 00 <br /> FEDERAL TAX IO NO OR S.A. . 00 This amount will be reported in accordance with Section <br /> 6041 of the Internal Revenue Code. <br />