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:_-Ari JQAQUIN uuur4 I Y PUBLIC HEALTH SERVICE'S Repo7t 15255 <br /> ENVTRONMENTAL HEALTH DIVISION StOment Printed : 12 /18/96 <br /> 3941M WESER AVENUE — 3RD OR <br /> R,O 60 388 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-34.20 <br /> TO : <br /> <br /> <br /> <br /> L7 <br /> ATTN : SHARON WATSON Facility ID 004033 <br /> RE TOSCO SUPER T MARKET* <br /> 7'647'--g A-Cl F1 N <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> D <br /> Service Activity <br /> ate Description <br /> Hrs Employee Amount <br /> Invoice # 034664 -- Date of Invoice : 12/17/96 <br /> 12/17 /96 2360 UST Permit Fee 'rank # TA505679 $170 . 00 <br /> 12/17/96 2360 UST Permit Fee Tank # TA505681 $170 . 09 <br /> 12/17/96 2360 UST Permit Fee ----Tank—#—TA5OS680-- -------$170 <br /> ---- — -------- --- — ------ <br /> 0 :) <br /> Total for this invoice: i5j: @@ <br /> Payment DUE DATE 01/18 97 <br /> If this INVOICE has been Paid, Please Disregard this Notice <br /> PAYMEN1 <br /> nP17FIVED, <br /> JAN 2 1 '19-97, <br /> SAN J0A0Ujt\,i COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENV!RCNMENTAL HEALTH DJ�VlSiONI <br /> PENALTIES for all FEES for SERVICE will be OSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMIT Fe at the rate of 101 of the Service Fee <br /> at the rate of 1001 of the Base Fee 31 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: $510 80 <br /> Please Make CHECKS PAYABLE to : 0-0 0`::' <br /> I <br /> j 0:0 DO $0 . 00 <br /> $510 700 $ $0 . $510 . 00 <br /> 0 to 30 days 31 to 60 days 61 .to 90 days 91 to 120 days 120 days Account <br /> Balance <br />