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SAN.IOAOIJIN COUNTY PIJBI,IIC k. .ALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 F,WEBER AVE,-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209-468-3420 <br /> AR0018279 <br /> FA0011279 <br /> Facility ID <br /> Date Printed 2/28/01 <br /> FRANK DOMINGUEZ RE : CUSTOM METAL FINISHING <br /> CUSTOM METAL FINISHING 1550 SHAW RD#C <br /> 1550 SHAW RD#C STOCKTON CA 95215 <br /> STOCKTON CA 95215 OWNER: CUSTOM METAL FINISHING <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0081374--Date of Invoice: 1130/01 <br /> 1/30/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 23J9 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice 5110.00 <br /> _ Payment Due Date1 <br /> t TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to : PHS/EHD / Return a Copy of This STATEMENT with Your PAYM <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 /> PAYMENT <br /> RECEIVED <br /> MAR 13 2001 <br /> I�„, A,wrrry <br /> rlX1li ;, ?� Isi_hViCEs <br /> FN,. i, I,u T I I):VISION <br /> 5255.rpt <br />