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SAljr3 .4QU7v C�9C1NTlY "P,UBS�C HEALTH SERVICES Report #5255 <br /> EN NMEN 7AL HEALTH {IVT ONT-. <br /> 4 4 5 t��,s-A�1'ta O QU(Ilj 5T�&�1E�I C J <br /> P 0 68��' 3,08 <br /> STOCKTON ' CA 95201-0388 } <br /> Accounting Office : 209 4680340 <br /> W'4 r_:c C:r t> r.,.x r"r t::: S3 'Y::: : 'p -k::: ea W.r..r t e....i t: <br /> TO : PAIN STREET'$EACON #474 <br /> 3440 E MAIN ST Account # 0009105 <br /> STOCKTON , CA 95205 <br /> ATTN : SCHAIL HAFAIZ Facility ID 006423 <br /> RE : MAIN STREET BEACON #474 Billing Date. ,01/11/95 <br /> -344,0�-f-M, .__ST_. :S70CKT0N <br /> PLEASE RETURN THIS STATEMENT WITH YOUR PAYMENT <br /> Service Activity <br /> E)a <br /> e Descriptiop Hrs Employee Amount <br /> Invoice # 017186 -- Date of Invoiol : 01/11/95 <br /> 01 /11 /95 2380 Underground Tank Per t Fee fpZf��Z $170 . 00 <br /> 01/11/95 2380 Underground Tank Pert Fee (03 $170 . 00 <br /> 01 /11/95 2380 Underground Tank Perm Fee 6y $170 . 00 <br /> - _ <br /> Total for this invoice 510.00 <br /> If this INVOICE has been Paid , Please Disregard this Notice . . . <br /> and DEDUCT the Amount Paid from the TOTAL DUE <br /> PAYMENT <br /> RECEIVED <br /> JAN n <br /> SAN <br /> PUBLIC <br /> ENVIRONMENiA, ,,_., Jnl ON <br /> Penalties will be added on all PERMIT FEES <br /> at the rate of 100% of the Base Fee <br /> 60 days after the invoice : date . <br /> For all SERVICE FEES penalties will <br /> be added at the rate of 10% <br /> 60 days past the invoice date and <br /> each 30 days thereafter . <br /> TOTAL DUE this Billing Period:_,_,_ 551.0..00 <br /> Account 1-30 Days 31-60 Days 61-90 Days 91--120 Days W121+ Plus <br /> Summary <br /> 610 . 00 0 . 00 0 . 00 0 . 00 0 . 00 <br />