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/ r <br /> s <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report 15252 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBFR AVE — 3RD FLOOR <br /> STOCKTON, CA 95202 209-468-3420 <br /> Billing <br /> TO : LOCAL FOOD STORE #1 Account # Date <br /> 2650 MONTE DIABLO ST SJ9 <br /> STOCKTON , CA 95203 0003424 12/1 7 <br /> ATTN : LIAQAT KHAN Facility 10 <br /> RE : LOCAL FOOD STORE #1 003836 <br /> 2650 MONTE OIA-BIO ST STOCKTON �_� <br /> PLEASE RETURN INVOICE NOTICE WITH PAYMENT <br /> V Health <br /> 1' Date Program Description Amount <br /> nvoice # : 0441,62 <br /> 12/12/97 2380 Underground Tank Permit FeeDy $170 . 00 <br /> 12/12197 2380 Underground Tank, Permit Fee I $170 00 <br /> x2/12 � <br /> /97 2380 Underground Tank Permit Fee 'IQ lQ k / $170 . 00 <br /> 12/12/97 2399 UNIFIED PROGRAM FAC STATE SERVICE FEr $18 . 50 <br /> Total for this invoice : $528 .;60 <br /> PAYMENT - <br /> WECEIVED <br /> JAN - 61998 Total Due: $528. 50 <br /> SAN JOAQUIN COUNTY Payment DUE DATE : 01 /. 98 <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL"'I's" NVOICE is for the ANNUAL <br /> Environmental Health PERMIT FEES <br /> for this FACILITY <br /> [January 1 , 1998 to December 31 , 1998] <br /> - If this ACCOUNT has other charges due, <br /> a complete monthly ACCOUNT STATEMENT will be <br /> sent after December 20th <br /> Penalties will be added on all Permits <br /> at the rate of 100% of the Base Fee 30 <br /> days after the due date . <br /> Please make Checks PAYABLE to : PHS/EHD <br /> L <br />