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SAra 7OAQUIN COUNTY PUBLIC HEALTH SERVICES Report #5255 <br /> ENVI-PL-flNMENTAL HEALTH DIVI -N <br /> 1145 N SAN JOAQUIN STREET WF <br /> Pfl BOX 388 <br /> 9,T0r.Ktd7�, CA 95201-0388 <br /> Accounting, Office : 209 468w-0340 <br /> Ph <".: c. w r...r r-I I,- t.: t-� „ r..�.y r t-b t:, <br /> TO : MANTECA HOSPITAL --m— <br /> PO BOX 191 Account ## 0005851- ' <br /> MANTECA , CA 95336r__w- <br /> ATTN : MANTECA HOSPITAL Facility ID 000853 <br /> RE_: MANTECA HOSPITAL f 1 q g Date: 01/11/95 <br /> 1205. E NORTH MANTECA 1 l <br /> PLEASE RETURN THIS STATEMENT WITH YOUR PAYMENT <br /> Service Activity <br /> Date Description Mrs Employee Amount <br /> Invoice # 016814 Date of Invoice: 01/11/95 <br /> 01, /11 /95 2330 Underground Tank Permit Fee /�- }o� $170 . 00 <br /> Total. for this invoice : $170.00 <br /> If this INVOICE has been Paid , Please Disregard this Notice . . <br /> and DEDUCT the Amount Paid from the TOTAL DUE <br /> sj � <br /> E B u U 19950 <br /> ENVIRONMENTAL HEALT 1 <br /> PERMIUSERVICES <br /> Penalties will be added on all PERMIT FEES <br /> at the rate of 100° of the Base Fee <br /> 60 days after the invoice date . <br /> For all SERVICE FEES penalties will <br /> be added at the rate of 10% <br /> 60 days past the .invoice date and <br /> each 30 days thereafter . <br /> TOTAL DUE this Billing Period : $170.00 <br /> Account 1--30 Days 31- 60 Da 61--90 Days 91-120 Dayj <br /> 121+ Plus <br /> Summa ry <br /> 1.70 . 00 0 . 00 0 . 00 0 . 00 0 . 00 <br />