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| <br /> SAN JOAQUIN COUNTY PUELIC wEALTH SERVICES Report #5255 <br /> ENVIRONMENTAL HEALTH CIVI N Sta men t Printed : 05/20/99 <br /> <br /> <br /> <br /> D # 0016997 <br /> STOCKTON , CA 95204 <br /> ATTN CRAIG FURGISON Facility ID 009997 <br /> RE : COUNTRY CLUB � ERVICE <br /> 1403 W COUNTRY CLUB BLVD <br /> STOCKTON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee AMOLI[It <br /> Invoice # 057142 Date of Invoice : 05/18/99 <br /> Total for for this invoice : <br /> Payment DUE DATE 06/20/99 <br /> If this INVOICE has been Paid, <br /> Invoice # 059332 olom ; 05/18/99 <br /> 05/18/99 2220 SM YR $100 . 00 <br /> 05/18 /99 2399 UNIFIEC PROGRAM FAC STATE SERVICE FEE $10 . 00 <br /> ------------------ <br /> MI"-l"T-Wr <br /> this involoe : <br /> »°=~— <br /> Pay-ment DUE DATE 999 <br /> If this INVOICE has been Paid. Plea e Disregard this Hoboo <br /> jug <br /> ~— For all S[KY[C[ FEES penalties will <br /> Penalties will be added o all Permits be added at the rate of 10% 60 days <br /> at the mb of 100% of tie Base Foe 30 past invoice date and each 0 days <br /> days after the d dote. thereafter. <br /> TOTAL DUE this Billing Period : <br /> Please make Checks PAYABLE to : PHS/EHD <br />���� ' <br />