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r209-468-3C420 <br /> UIN COUNTY PUBLIC HFysLTH SERVICES Page 1 <br /> MENTAL HEALTH DIVI <br /> ER AVE-3RD FLOOR <br /> N, CA 95202 <br /> INVOICE Acwunt I AR0009105 <br /> Facility 1 FA0006423 <br /> Date Printed4/24/00 <br /> SOHAIL BAFAIZ&KHALIL BAFAIZ RE: MAIN STREET BEACON#474 <br /> MAIN STREET BEACON#474 3440 E MAIN ST <br /> 3440 E MAIN ST STOCKTON CA 95205 <br /> STOCKTON CA 95205 OWNER: BAFAIZ,SOHAIL/BAFAIZ,KHALIL <br /> Health <br /> Date Program Description Firs Employee Amount <br /> Invoice# IN0069744---Date of Invoice: 4119100 <br /> 4/19/2000 2301 UST STATE SURCHARGE $24.00 <br /> 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee Tank#004 $170.00 <br /> 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee Tank#005 $170.00 <br /> 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee Tank#006 $170.00 <br /> 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoicel $544.00 <br /> Payment Due Date 6/24/2000 <br /> TOTAL DUE this Billing Period 544.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> 1"HT IViY='�Irk <br /> my -1? <br /> SAN JOAQUIN COUNTY <br /> PUBUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5255.rpt <br />