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EtdVIR,OPJrIENTgLVHEALTPUBLI E'ALTH ON <br /> H DIV SERVICES <br /> 0 E BER AVENUE p Re ort <br /> PO BOX 388 � 3RD LOOK 5 meat Printed : #5255 <br /> 02/0,/.6STOCKTON. CA <br /> 95201TM0388 <br /> Accounting Office : 209 468_-3420 <br /> R:: <br /> TO : C KELLEY TRUCKING <br /> G 4569 E WATERLOO RD <br /> STOCKTON , CA 55205 <br /> Account # 0003329 <br /> ATTN: C KELLEY TRUCKING INC — —` <br /> RE : C KELLEY TRUCKING Facility ID 003750 <br /> j969 E WATERLOO RD ._ ST.QCKTON --_, <br /> PIERSE RETURN a COPY of THIS STATEMENT with YOUR p HENT - <br /> Date Description Service Activity <br /> _ Hrs Employee <br /> Amount <br /> Invoice # 026365 -- Date of invoice : <br /> 02/05/96 2301 UST State Surcharge Fee 02/05/96 <br /> Tank # TA175401 <br /> ----------------------- $5 <br /> Total for this invoice ___–��_ -'._ <br /> If this INVOICE has been Paid, Please Disregard this Notice Payment DUE DATE $56. 00 <br /> 03/06/96 <br /> PAYMENT <br /> RECE4Yr. i',, <br /> FEB 12 1996 <br /> SAN JOAQLIiN urti r <br /> - ALAQC HEALTH SF:t?y�?CE <br /> ENVIRONMENTAL HEALT�i L�IV151Cjn, <br /> t <br /> PFXAITIfS ai11 be kSSfSSEo as all A#111 PERMITS <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> f 1@� of <br /> at the rate of IM of the Base Fee at the rate ohie Service Fee <br /> 30 days after the Payment DUE DATE, 30 days after the Payment DUE DATE <br /> and EACH 30 days thereafterL. ::�;$756 <br /> :== <br /> TOTAL DUE this Billing Period : y <br /> __ — ___---_ r I <br /> Account 1-30 Days 33 60 Days — � ,m <br /> Summar <br /> y6190 Days 51-120 Days , 323.+ Pius <br /> 226 00 <br /> 0 . 00 0 . 00 <br /> 0 . 00 <br /> 3� <br />