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44vY Nh9ENTAL HEALTH 3DIVONRDjQOOR SERVICES <br /> 3 E " WEBER AVENUE �t Report ►5255 <br /> PO BOX 38$ a merit Printed 12/18/96 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> TO : C KELLEY TRUCKING <br /> 4969 E WATERLOO RD <br /> STOCK CA7cc(u)unt0003329 <br /> TON, CA 95205 <br /> ATTN : C KELLEY TRUCKING INC <br /> RE : C KELLEY TRUCKING Facility ID <br /> KING <br /> _.Facility <br /> C...bJATf WATERLOO RD ._ r: _'. <br /> �TOCKTCN j <br /> PLEASE RETURN a COPY of THIS STATEMENT with YDIIR PAYMENT 3 <br /> Date Description Service Activity <br /> ---—�-- Hrs Employee <br /> A m o u n t <br /> Invoice # 034515 Date of <br /> 12/17 /96 2380 UST Permit F=ee Invoice: 12/17/96 <br /> Tank # TA175401 <br /> ----------___---___ — __ . 0© <br /> Total for this invoice- <br /> If this INVOICE has been Paid, Please Disregard this Notice Payment DUE DATE * <br /> ATE $170. 08 <br /> PAYMEN t <br /> DEC 3 O1996 <br /> SAN JOAQU1ld COUNTY' <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH Dlvf5fOt\l <br /> PENALTIES will be ASSESSED an all ANNdII PERMIT Fe PENALTIES for all FEES for SERVICE will be ASSESSED <br /> at the rate of 100t of the Dist Fee at the rate of III of the Service Fee <br /> 3o days after the Payment DUE DATE. 31 days after the Pay'nent DUE DATE <br /> and EACH 30 days thereafter. <br /> TOTAL DUE this Billing Period: <br /> Please Make CHECKS <br /> 170. 08 <br /> ---$17 0 .J,0 $0 $0 . 00 N.,.R D.b �0�. <br /> _00 <br /> 0 . 00 <br /> 0 to 30 <br /> days 31 to bl days51 to 99 da s ,,.� <br /> Mance y 91 to 121 days } 120 days Account <br /> _ <br />