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EN.VIRG,NMENTAL HEALTH .OIVI�ION St_etement ' Tinted : 01 /23/96 <br /> 3?d E� WEBER AVENUE — 3RD *4W 18/ <br /> PO BOX 388 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> = r-t <br /> TO : CALIFORNIA HIGHWAY PATROL #266 <br /> <br /> <br /> ATTN : CALIFORNIA HIGHWAY PATROL Facility ID 003682 <br /> RE : CALIFORNIA HIGHWAY PATROL #266 <br /> 385 W GRANT LINE RD TRACY <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # 025639 -- Date of Invoice : 01/22/96 <br /> 01/22 /96 2380 UST Permit Fee Tank # TA190401 $170 . 00 <br /> -----— — — ----- <br /> --- ---- -------- <br /> --—— 00 <br /> Total for this invoice : 17 <br /> Payment DUE DATE 02/21/96 <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> - PAYMEN1 <br /> APPROVED FOR PAYMENT REriF;r Jr'r? <br /> Tracy -266 FEB 2 31996 <br /> ............ <br /> • • • • • •• •• 3AN JOAUui,4 COUNTY <br /> Signature PUBLIC HEALTH SERVICES <br /> Tifl_, ED # 1. <br /> ENVIRONMENTAL HEALTH CIVISION <br /> . . . . .. . <br /> beer. <br /> Date 'Z . . . . .b be"-original m Presmrzd for retard,cod l W. <br /> pays ePs and har W. <br /> . . . . . . . . . . . . . . . . . . . Previously been poid.We hon recorded thb PoynMN a <br /> Date Goods Received os so Prem/o loser dupficti poyme ry <br /> (If Applicable) signed NXA� g'_ <br /> DEP R A hC.CX/MING QeFiCER <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMITS at the rate of 10% of the Service Fee <br /> at the rate of 100% 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 : $170 . 00 <br /> i <br /> Account1-30 "Days 31-60 Days 61-90 Days 91-120 Days 121+ Plus <br /> Summary <br /> 170 . 00 0 . 00 0 . 00 0 . 00 0 . 00 <br /> v �/ <br />