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FORWARD, INC. R <br /> 1 145 UVesit Charter illfay <br /> INVOICE <br /> Stoddaton, CA 95206 Mvoice Cite 08/31/2018 <br /> Invoice No 42044X)0051371 <br /> REPUBLIC Customer No 4-4204-0010317 <br /> BERMES <br /> ii tnutDT1 AJ MOM Page No 1 of 2 <br /> •1!1'1lIIlII'LIIl1""'I'llIII"IlIIII�I8III°IB'III°'IIII'1111111 Due Date 09/30/2018 <br /> FI&H ENGINEERING CONSTRUCTION <br /> fAARIA JAIMES Current Charges Total Amount Due <br /> 212 INDUSTRIAL DRIVE - -----_ _-__-- <br /> --..�,•- ;� �-.. . $69624 -------I <br /> STOCKTON, CA 95206SEP - <br /> Please Part'Tota!Amount Due <br /> Billing Questiions?Call 209-466-4492 <br /> s�. <br /> IMPORTANTII! To ensure your paynx <br /> we need <br /> the torn remittance from your invoice <br /> R+alenence <br /> 08123 VS SW-Ti1MSER/iREgTED/OLD - _ Y _- Amount <br /> a Y8 13251% 6145 9.28 P4 614 50 <br /> 08123 VS Reference.3034968 <br /> 08/23 VS Vehicle:HJELM J15 <br /> CDLOw <br /> 08/23 VS Contract: 4204122008 <br /> z <br /> 08123 VS Generator Name- H&H ENGINEERING <br /> z 08/23 11 ENVIRONMENTAL FEE 1 SC786623 16.25 1.00 16.25 <br /> zz 16.251 Ticket)ENVIRONMENTAL FEE 1 <br /> z <br /> z 08/23 )1 FUEL RECOVERY FEE SC786624 4461 1.00 44.61 <br /> z (7.26%/Ticket)FUEL RECOVERY FEE \� <br /> z <br /> z SJ Cnty I AB 939 Fee at 2.00/TN �a <br /> 0 00 9.28 18.56 <br /> z SJ Cnty /Rd Mitigation Fee at 0.16/TN /y\ � 000 9.28 1.48 <br /> � <br /> SJ Cnty I Erw Health Fee at 0.09/TN a �� 0 00 9.28\ 0.84 <br /> --Material Summary---- (� <br /> SW-TIMBER)TREATED/OLD 9 28 <br /> s SEP 19 MR <br /> ACCOUNT STATUS <br /> ru Current 31.0"S es"Days Over t'0 pays Total Amount_tine <br /> o ---- — — _ <br /> A $1,410.48 1_ 0..00 $1,410_45 <br /> v <br /> +� 4 Please return this portion below with your Payment.Do Trot attach check to stub. Z Z <br /> FORWARD, INC. -----------------------------:;: <br /> R` Invoice Date 08/31/2018 <br /> � 1145 West Charter Way Invoice No. 4204-000051371 <br /> �4 <br /> Stockton,CA 95206 Customer No. 4-4204-0010317 <br /> REPUBLIC <br /> seu��css <br /> Current Charges: $696.24 <br /> Total Amount Due: $1,410.46 <br /> Please check if address has changed,and indicate change(s)on reverse side or call phone number above. Amount Paid: <br /> Please write your account ntxTiber on your check and make payable to: <br /> IIIIIIIIII i IIIA IIIII I IIVIII-1-111I II H&H ENGINEERING CONSTRUCTION <br /> 1 • 1•h •Ihm 11I d rl I r11. I ° MARIA JAIMES <br /> FORWARD INC. 212 INDUSTRIAL DRIVE <br /> Please Return PO BOX 31001-2265 STOCKTON, CA 95206 <br /> Payment To: PASADENA, CA 91110-2265 <br /> 4420490103170000009051371000OL962411091419465 <br />