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.—r <br /> ,^L-fi—EPae 1ALTH DEPARTMENT 9 <br /> ..r+LELTON AVENUE <br /> i OCKTON, CA 95205 y <br /> Phone: (209)468-3420 <br /> Account ID AR0027280 <br /> <br /> <br /> Date Printed 10/31/2019 <br /> EXEL INC RE : EXEL INC <br /> 11950 HARLAN RD 11950 HARLAN RD <br /> LATHROP, CA 95330 LATHROP, CA 95330 <br /> OWNER : EXEL INC. <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0328260---Date of Invoice: 9/26/2019 ���������������������������������������������� � �� ��111 1111 111111 11111 1111 IN <br /> 9/26/2019 1921 HMBP-Regular-Primary Location $ 789.00 <br /> 9/26/2019 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2019 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 1,117.00 <br /> Payment Due Date 10/27/2019 <br /> TOTAL DUE this Billing Period $ 1,117.00 <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />