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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report #5252 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE — 3RD FLOOR <br /> STOCKTON, CA 95202 209-468-3420 <br /> Billing <br /> Account # Date <br /> TO : DOCTORS HOSPITAL OF MANTECA <br /> PO BOX 191 0000851 .12/155/97 <br /> MANTECA , CA 95336 <br /> ATTN : DOCTORS HOSPITAL OF MANTECA Facility ID <br /> RE : DOCTORS HOSPITAL OF MANTECA 000853 <br /> 1205 E NORTH MANTECA <br /> PLEASE RETURN INVOICE NOTICE WITH PAYMENT <br /> Health <br /> Date Program Description Amount <br /> Invoice # : 043922 <br /> 12/12/97 2213 HAZ WASTE CE FAC STATE SERVICE FEE $20 . 75 <br /> 12/12/97 2315 Underground Tank Permit Fee $170 . 00 <br /> 12/12/97 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $18 . 50 <br /> Total for this invoice : $209 .25 <br /> Invoice <br /> Invoice 4' 044430 <br /> 12/12/9'7 _'.'2234 HAZARDOUS WASTE CESW FACILITY PERMIT $100 . 00 <br /> for this invoice : $100.00 - <br /> VENDOR # _ w <br /> DUE 0ATE - <br /> F?.Q..' Total Due : $309 . 25 <br /> A/C CODE <br /> W .Payment DUE [LATE : u�01 ...._s, clsi <br /> 5 INVOICE is for the ANNUAL <br /> Misc. ronmental Health PERMIT FEES <br /> 77 for this FACILITY <br /> ' 'PROVED BY 1 , 9.998 to December 31 . 1998] PA� <br /> f�-i,a.—ef0--this ACCOUNT has other charges due , <br /> a complete monthly ACCOUNT STATEMENT will be <br /> sent after December 20th DEC 3 Q 199, <br /> E'NVQNA <br /> C , <br /> CO <br /> &k ,si <br /> Penalties will be added on all Permits ry <br /> at the rate of 100% of the Rase Fee 30 LHELrNIcLts <br /> slaM <br /> days after the due date . <br /> Please make Checks PAYABLE to: PHS/EHD <br />