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>o - U 'CO <br /> SAN JOAQUIN COUNTY <br /> j ENVIRONMENTAL HEALTH DEPAR� N'( <br /> . `a�'Js �'`` • RECEIVED <br /> Administrative Hearing Fee Payment In��Rggim <br /> To Be Filled Out By Staff Only SAN jpA(aUIN t4TAL <br /> ENVIROMENTAL <br /> TH DEPARTMENT <br /> Facility ID#: F A btu a i-Ja3P/R ID#: k 53) i LI S <br /> Account ID#: A 2ools(o5 Invoice#: <br /> Facility Name: (��i c l '�Y-Ua C D <br /> Facility Address: a i`5�t 3 S , E( i2u ou�o <br /> Employee#: c G'Z.141 Service Code: 552 <br /> Program Element: qL i'3() Date of Hearing: 1 ) <br /> To Be Filled Out By Accounting Only <br /> Payment Date t__fee.Amount Amount Paid Che Cas Re6jj3y <br /> 1 /6 13 $ o2c`�D ,iso $o'Z50 •��' <br /> EHD 4&02-031 Admin Hearing Fee Payt. <br /> 11/13/2002 <br />