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FORWARD, INC. <br /> 1145 V1/est Cfaarter`W a y INVOICE <br /> Stockton, CA 95206 lnvoiice Date 12/31/2017 <br /> Invoice No d204-C-00049,820 <br /> REPUBLIC Customer No 4-4204 00�0317 <br /> SEFVJCES <br /> 1uar1STLOnn n gage No 1 of 2 <br /> �loO�lr��alv�r��l'1'll'�II�III"�II�IIIilhllll�••ll11'111-1141 Due Date 93J3 Q018 <br /> IH&H ENGINEERING CONSTRUCTION <br /> MARIA JAIMES Current Charges Total Amount Due <br /> 212 INDUSTRIAL DRIVE <br /> STOCKTON, 'CA 95206 <br /> Please Pay Total Amount Due <br /> Billing Questions? Cali 209-466-4482 <br /> F <br /> PORTANTH! To erasure your payment is Posted to the co,7ect inv®ice, wre need <br /> torn remittance from your invoice. Thank you. <br /> Code Description -- - — . - --- — <br /> _ Reference Rate Quantity Amount <br /> unt <br /> 1200 VS t,', -IMBERITREATE„LLD — --YS 1279600 58.50 1 L51 >ti ti73 34 <br /> a 12,E VS Reference-4297827 <br /> 12r20 VS `Vehicle OCC 3352 .DCC 40YD <br /> p 120 VS Contract 4204122W8 <br /> Z 12/20 VS Generator name: H&H ENGINEERING <br /> z 12120 11 ENVIRONMENTAL FEE 1 S�'719786 1625 1.00 1625 <br /> z ( 16.25/Ticket)ENVIRONMENTAL FEE 1 <br /> z 12120 11 FUEL RECOVERY FEE 80719787 4282 100 42.82 <br /> z {6.36%/Ticket)FUEL RECOVERY FEE <br /> z SJ Cnty/AB 939 Fee at 2.00/TN 0.00 11 51 23 D2 <br /> Z SJ Cnty/Rd Mitigation Fee at 0.16/TN ;q <br /> ; � � 000 1151 184 <br /> ——Material Summary <br /> g SW-TI MBERITREATEDIOLD 1151 y <br /> 16 <br /> 0 <br /> ACCOUPITSTATUS H&H, ENG. <br /> u Qur t 31 i0 Wys a 1396E Days over so Qw�s Trrg1 Amount Due <br /> $a 471.87 a_rm o 00 <br /> - ------ - 0 $1,471.87o <br /> ♦ ♦Please return this �— <br /> Portion below with your payment.Do not attach check to stub. r{. i• <br /> -- -----^--- -----------------------------------------—------------ — <br /> FORWARD, INC. Invoice Date 12/31/2017 <br /> 1145 West Charter Way Invoice No. 4204-000049826 <br /> Stockton CA 95206 Customer No. 4-4204-0010317 <br /> SEPUBLIC <br /> sERMEs <br /> Current Charges $757.27 <br /> Total Arnount Due: $1,471.87 <br /> Please check if address has changed,and indicate chap ge(s)on reverse side w Bali phone number above Amount Paid' <br /> Please write your account mumber on your check and make Rayawe to: <br /> lilllr Fill J MARIA AIMES RING CONSTRUCTION <br /> FORWARD, INC. 212 INDUSTRIAL DRIVE <br /> Please Return PO BOX 31001-2265 STOCKTON, CA 95206 <br /> Payment To: PASADEPJA, CA 91110-2265 <br /> 44204961,6c3176,090ODC04c:1826OGGG757270001 71879 <br />