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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Stoment Printed : 12/18/96 <br /> E,AVIJWONMENTAL HEALTH DIVI N <br /> x"04 E WEBER AVENUE – 3R0 OOR <br /> PO BOX 388 <br /> :,TOCKTON , <br /> CA 95201-0388 <br /> Accounting' Office;: � „L09. 468-3'420 . <br /> T0 : COLLEGEVILLE MARKET & CAFE* <br /> Account # 0001456` <br /> X3521 E MARIPOSA RD _ <br /> STOCKTON , CA 95205 <br /> Facility ID 001457 <br /> ATTN : COLLEGEVILLE MARKET & CAFE <br /> - RE .–COLLEGEVILLE <br /> 4 RKE-T &--GA+-E-*, -- <br /> ••--u- <br /> 13521 E MARIPOSA RD STOCh:TON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Hrs Employee Amount <br /> [Dae Description v <br /> Date of Invoice : 12/17 /96 $170 . 0© <br /> 6 <br /> Invoice # 034370 -- Tank # TA22590 $170 0q <br /> 12 /17 /96 2380 UST Permit Fee Tank # TA225907 <br /> 12 /17/96 2380 UST Permit Fee ----------------------------- – <br /> Total for this invoice : - 01/18/97 <br /> Payment DUE DATE <br /> If this INVOICE has been Paid. Please Disregard this Notice . . <br /> JAN211997 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PENALTIES for all FEES for SERVICE will be ASSESSED,' <br /> at the rate of 108 of the Service Fee <br /> PENALTIES will be ASSESSED on all ANNUAL PERMIT Fe 30 days after the Payment DUE DATE <br /> at the rate of 1008 of the Base Fee. and EACH 30 days thereafter. <br /> 30 days after the Payment DUE DATE. <br /> TOTAL DUE this Billing Period: <br /> R:.:n y...8 <br /> Please Make CHECKS PAYABLE to : $© ®© ` <br /> $340 . 00 <br /> 31 to 60 days 61 to 90 days 91 to 120 day's ) 120 days <br /> Acc <br /> 0 to 30 days <br /> Balance <br />