Laserfiche WebLink
SAN:LOAQUIN COUNTY <br /> ONVIk MENTAL HEALTH DEPARTMEi ' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> jINVOICE Account ID F AR0026892 <br /> f Facility ID I FFA0015585 <br /> _.. <br /> -------_-.-- -.-.._. . Date Printed F 3/23/2005 <br /> PENNINGTON,SUNG HI RE : PENNINGTON, SUNG HI <br /> 9135 N HILDRETH LN 10285 N HILDRETH RD <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 <br /> OWNER : PENNINGTON,SUNG HI <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0131636---Date of Invoice: 3/22/2005 I IIIIIII IIIIII III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII ILII IIIIII IIIII IIIIIIII <br /> Hrs Employee <br /> 2/2/2005 3030 312-CONSULTATION 0.50 INFURNA $ 46.50 f <br /> 2/4/2005 3030 310-FIELD CONSULT 6.90 INFURNA S 641.70 <br /> 3/23/2005 3030 315-REPORT REVIEW 3.10 INFURNA $ 288.30 <br /> - Total for this Invoicel $ 976.50 <br /> Payment Due Date 4/22/2005 <br /> I <br /> TOTAL DUE this Billing Period $ 976.50 <br /> i <br /> i <br /> i <br /> i <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 OES/HMMP 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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30.Days thereafter <br /> 5255.rpt <br />