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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report #5255 <br /> ENVIRONMENTAL HEALTH DIVISION Stgtement Printed : 01/23/96 <br /> 3jr4 E. WEBER AVENUE — 3RDWOOR <br /> PO BOX 388 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> T_ <br /> TO : MAIN STREET BEACON #474 <br /> 3440 E MAIN ST Account # 0009105 <br /> STOCKTON , CA 95205 <br /> ATTN : SCHAIL HAFAI2 Facility ID 006423 <br /> RE : MAIN STREET BEACON #474 <br /> 3440 E MAIN ST STOCKTON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # 025874 -- Date of Invoice : 01/22/96 <br /> 01/22/96 2380 UST Permit Fee Tank # TA504864 $170 . 00 <br /> 01/22/96 2380 UST Permit Fee Tank # TA504863 $170 . 00 <br /> 01/22/96 2380 UST Permit Fee Tank # TA504862 $170 . 00 <br /> --------y----------------------- -- <br /> Total for this invoice: 10 <br /> Payment DUE DATE 02/21/96 <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> PAYMIENY <br /> RECEIVr7 n <br /> FEB 2 21996 <br /> SAN JOAQUIN COU,vTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMITS at the rate of lot of the Service Fee <br /> at the rate of IOD% 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 /> Account Days 31-60 Days 61-90 Days 91-120 Days 121+ Plus <br /> Summary [_::l:-30 0 . @0 0 . 00 0 . 00 0 . 00 <br />