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`;AN JOAQUIN COUNTY PUBLIC �41EALTH SERVICES ' Report t5155 <br /> ENVIRONMENTAL HEALTH DIVI N Ste nent Printed : 01 /29/9'3 <br /> "`( <br /> <br /> : 209 468-3420 <br /> TO : ARCO STATION #2133* ---_ ---- - <br /> PO BOX 6038 Account # 0003203 <br /> ARTESIA , CA 90702-6038 --- --- <br /> ATTN : ENVIRONMENTAL HEALTH & SAFETY Facility ID 00362 v1 <br /> RE : ARCO STATION #2133* <br /> 2908 W BENJAMIN HOLT <br /> STOCKTON _ <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Actii,ity <br /> Date Description Hrs Employee Amount <br /> Invoice 0 054093 -- Date of Invoice : 01/28/99 <br /> 01 /28/99 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE: $10 . 00 <br /> 01/28/99 2315 UST Permit Fee Tank # TA102101 $170 . 00 <br /> 01/28/99 2315 UST Permit Fee Tank # TA102102 $170 . 00 <br /> 01/28/99 231.5 UST Permit Fee Tank # TA102103 $170 . 00 <br /> 01/28/99 2315 UST Permit Fee Tank # TA102106 $170 . 00 <br /> 01/28/99 2301 UST State Surcharge Fee Tank # PR507761 $8 . 0 <br /> ---------------------------------------- <br /> Total for this invoice : 698 . 0 <br /> Payment DUE DATE 03/01/9 <br /> If this INVOICE has been Paid, Please Oisregard this Notice <br /> PAy11 ENT <br /> 11999 <br /> "H!�JvilUtlV t,Cji?NVY <br /> PUBLIC HEa.LTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> For all SERVICE FEES penalties will <br /> Penalties will be added on all Permits be added at the rate of lit 66 days <br /> at the rate of lift of the Base Fee 31 past invoice date and each 30 days <br /> days after the due date. thereafter. <br /> TOTAL DUE this Billing Period . _ $698.00 <br /> Please make Checks PAYAB_L---to': PHS/EHD <br />