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} <br /> SAN .."I'�-JAQUIN L`,.ICHAL FEP4.L-iH 1_;F}'lid- <br /> ('209-) 468-:34,2-15 <br /> jogi i'.IFclma, M.D. , HIfYa:th Of f ices - <br /> ..Fyf'.Y _! ANrC. PCTERS TrC� <br /> G. kiln 831 4.._L i+ i' . °11 <br /> iL1iTi _ .at.eri€ent For 1 Pe %ir:if., aGilit-Y. <br /> Statement Date January 151 V 8:3 <br /> Payment Due iiatell Fer-:•ua y 15, ICU_ <br /> FtCiit Fed i1.ti�.E49 <br /> Wnia4:?�4' uui ber 1 004. 3f}.1)1 <br /> .jAL FEES <br /> N0 T ES <br /> Not't f y -he :arid 1 :Toaqu 3 n? L k c a i <br /> Health District 1f ariy <br /> Cie mailed upon receipt of <br /> paymejj?t and approval of <br /> fsCi3iti•y . <br /> j <br /> Rett it payii nt along with one . <br /> copy of t6his Statement to: <br /> ENVIRONMENTAL HEAI 1H YERMIUSERVIi•ES <br /> P.0, BOX 2131)4 <br /> �+sE <br /> 95201 <br /> � <br /> : T-iiiK ON, CA J5li 1 <br /> Feiialt•ieS will be a&&d afte'E <br /> due date as sholl#rl <br /> days 100% of Base Fee <br /> t � <br /> t r„ <br /> �- <br />