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SAN JOAQUIN COUNTY PUBLTC HFALTH SERVICES <br /> I I,# Report 1521.5 <br /> I <br /> W IENTAL HEALTH 0 V -) Sta nt Printed .rited . 12/18/96 <br /> PO Box -BER AVENUE: --- 3RD FLOOR to <br /> 388 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> TO : CONNELL MOTOR TRUCK CO <br /> 2211 N WILSON WAY Ac'count 0003272 <br /> STOCKTON , CA 95208 <br /> ATTN : SHELDON HECKMAN <br /> Facility ID 00311�94 <br /> RE : RIVER CITY PETROLEUM CAROLOCK * <br /> i <br /> 2211-.._N W-ILS-ON ; WY S-T-0 C-K-T-014- <br /> RLEASE RETURN a Copy of THIS STATEMENT with YOUR PAYMENT <br /> Otte D e-�c r ip Service Activity <br /> H r s Employee Amount <br /> Invoice * 034481 Date of Invoice : 12/17196 <br /> 12/17/96 2315 LIST Permit Fee Tank # TA130405 $170 . 00 <br /> 121171.96 11315 UST Permit Fee Tank # TA130406 $170 . 00 <br /> 12/17/16 2315 UST Permit Fee Tank # TA, 130407 $170 . 60 <br /> ————————————-——————--- <br /> Total for this invoice: — ' —$510 . 9700 <br /> If this INVOICE has been Paid, Please Disregard this Notice <br /> _Payment.D.UE--.-D ATE 8- <br /> PAYMENI <br /> OEIVED <br /> 31997 <br /> $ANJ(')A0'JJN QQUNTY <br /> P1J8UQ H�AL,TFI SERVICES <br /> EWRONVIENTAL HEALTH DIVISI&\i <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMIT Fe at the rate of 10% of the Service Fee <br /> at the rate of 1008 of the Base Fee 30 days after the Payment DUE DATE <br /> 30 days after the Payment DUE DATE. <br /> and EACH 30 days thereafter. <br /> TOTAL DUE this Billing Period: <br /> $510 . 00 <br /> Please Make CHECKS PAYABLE to : r:." 4-1 9:3 <br /> $510 . 00 $0 . 00 $0 . 00 $0 . 00 <br /> I to 30 days 31 to 60 days 61 to 99 days 91 to 120 days y 121 days Account <br /> Balance <br />