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A1,1 JOAQUIN COUNTY PUBLIC 'HEALTH SERVICES � Report 05255 <br /> Eh4VSRONIHIENTAL HEALTH DIV' ON St ement Printed : 12/13/96 <br /> 304- -E WEBER AVENUE — 3RD :OOR <br /> PO BOX 338 � <br /> STOCKTON , CA 95201--0388 <br /> Accounting Office : 209 468--3420 s <br /> TO : CHEVRON #96171* -- -- <br /> +PO BOX 5004 � Accaunt # 0003422 <br /> SAN RAMON , CA 94583 <br /> ATTN : CHEVRON USA INC Facility ID 003834 <br /> RE CHEV ;7 <br /> x <br /> AIP CT FIC aVt ST0CrTON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # 034574 -- Date of Invoice : 12/17/96 <br /> 12/17/96 2360 UST Permit Fee Tank # TA178401: $170 . 0+ <br /> 1-1 /17/96 2360 UST Permit Fee Tank # TA178406 Y $170 . 40 <br /> 12/17 /96 2360 UST Permit Fee Tank # TA17840- $170 . 00 <br /> 12/17 /96 2360 UST Permit Fee Tank # TA178408 $170 . 00 <br /> Total for this invoice : $680.00 <br /> Payment DUE DATE 1/18/9 <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> PAYMEf O <br /> JAN 3 01997 <br /> SAN jOAQUIN CULt;, <br /> PUBLIC HEALTH SERVICES <br /> /-- -�.NVIRONMENTAL HEALTH <br /> . <br /> PENALTIES for all FEES ,for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMIT Fe at the"rate of h% of the Service Fee <br /> at the rate of 1008 of the Base Fee 30 days after the Payment DUE DATE <br /> 30 days after the Payment DUE DATE. and EACH 30 days thereafter. <br /> TOTAL DUE this Billing Period : $680.00 <br /> Please Make CHECKS PAYABLE to : IF-,, III <br /> $6a0 00 $c-�. 0� ... ..,...$..3'95 -00•.._ $4 . 00 $0 00 $485 . 00 <br /> 0 to 30 days 31 to 60 days 61 to 90 days 91 to 120 days ) 120 days Account <br /> Balance <br />