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AN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report 15255 <br /> NVIiR0NM2N''T'AL HEALTH DIVISI01 Statem, Printed: 11/17/97 <br /> 04 E WEBER AVENUE - 3 <br /> <br /> <br /> =rzvo ice <br /> TO: QB REBUILDER <br /> 5100 GOLDLEAF CIR Account # 0010247 <br /> LOS ANGELES, CA 90056 <br /> ATTN: QB P.EBUILDER FFacility ID 007080 <br /> RE : QB REBUILDEP. <br /> 2325 W CHARTER WAY <br /> STOCKTON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYHENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br />=nvoice # 032990 -- Date of Invoice: 11/04/96 <br /> 11/04/96 2228 GEN 25<50 TONS PERMIT $1 , 348 . 00 <br /> 12/04/96 PAYMENT $-1 , 348 . 00 <br /> 11/07/97 2229 GEN 50<250 TONS PERMIT $3, 371 . 00 <br /> 11/15/97 CORRECTION TO A CHARGE $1 , 348 . 00 <br /> ------------------------------------- <br /> Total for this invoice: 52,023 .02 <br /> Payment DUE DATE -- 12/17/97 <br /> If this INVOICE has been Paid, Please Disregard this Notice <br /> For all SERVICE FEES penalties will <br /> Penalties will be added on all PerTits be added at the rate of IM 50 days <br /> at the rate of 100% of the Base Fee 3e past invoice date and each 30 days <br /> days after the dce date. thereafter. <br /> TOTAL DUE this Billing Period: 52, 023 .00 <br /> Please make Checks PAYABLE to: PHS/EHD <br />