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?.N JOAQUIN COUNTY PUBLISEALTH SERVICES • Report #6255 <br /> AVIRONPIENTAL HEALTH DIVISION Statement Printed : 01 /13 /97 <br /> 34 E WEBER AVENUE — 3RD FLOOR <br /> TOCKTON , CA 95202 <br /> o lnting Office : 209 468-3420 <br /> TO : MAIN STREET BEACON #474 <br /> 3440 E MAIN ST Account # 0009105 <br /> STOCKTON, CA 95205— <br /> T'N : SCHAIL HAFAIZ Facility ID @06423 <br /> RE : MAIN STREET BEACON #474 <br /> 3449"- E_MAIN—5"7 - S'TOCI?'fif1N- -'— }} <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice $ 034695 -- Date of Invoice : 12/17/96 <br /> 12/17 /96 2380 UST Permit Fee Tank # TA5O4864 $170 . 00 <br /> 12/17/96 2380 UST Permit Fee Tank If TA5O4863 $170 . 00 <br /> 12/17/96 2380 UST Permit Fee Tank # TA5O4862 $170 . 00 <br /> Total for this invoice: $510 .00 <br /> Payment DUE DATE 01/18/97 <br /> If Chis INVOICE has been Paid, Please Disregard this Notice . <br /> Pe4 VIWEN <br /> JAN 2 2 1997 <br /> PUBLIC UAwLJIA C�. <br /> cNV/gpyVMENTAL H ALTHICES <br /> PENALTIES for all FEES for SERVICE will begJN$$ED <br /> PENALTIES will be ASSESSED on all AITHAt-fUMIT Fe at the rate of 10% of the Service Fee <br /> at the rate of 1B0t of the Base Fee 30 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 .00 <br /> P11ease Make CHECKS OAYABLE to : IF!:` II-II '`:?S. ,+" Ifki. H O E-or <br /> $510 . 00 $0 . 00 $0 . 00 <br /> 0 to 30 days 31 to 60 days 61 to 90 days 91 to 120 days ) 120 days Account <br /> glance <br />