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11N ;J AQUIN COUNTY PUBLIC HEALTH SERVICES Report #5255 <br /> IdVIJU>NMENTAL HEALTH DIV N St :iient Printed : 02/25 /99 <br /> r';'�A F <br /> <br /> ice : 209 468--3A20 <br /> TO : QB REBUILDER F <br /> 5.100 GOLDLEAF CIR ccount 4 0010247 <br /> LOS ANGELES , CA 90056 -s - <br /> ATTN : QB REBUILDER Facility ID 007080 <br /> RE : Q8 REBUILDER <br /> 2325 W CHARTER WAY <br /> STOCKTON <br /> PLEASE RETURN a COPY of THIS STATENENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # 054325 -- Date of Invoice: 01/28/99 <br /> 01 /28/99 222.9 GEN 50<250 TONS PERMIT $1 , 800 . 00 <br /> 01/28/99 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10 . 00 <br /> 02/15/99 Credit Adjustment <br /> Total-for this-invoice : - 7$862 .80i, <br /> Payment DUE DATE 28/99 <br /> If this INVOICE has been Paid, Please Disregard this Notice <br /> PAYMENT <br /> MAR 15 1999 <br /> SAN JOAQUIid:Xi:1N7'P <br /> PUBLIC HEALTH 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 108 60 days <br /> at the rate of 1618 of the Base Fee 31 past invoice date and each 31 days <br /> days after the due date. thereafter. <br /> TOTAL DUE this Billing Period : $862 0 <br /> Please make Checks PAYABLE to: PHS/EHD ��� <br />