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FORWARD, INC. Vi\V ICE <br /> 1145 West Chaalea Vvay <br /> Stockton,CA 95206 � Invoice Date 06i15/2019 <br /> Invoice No 4204-0000.53031 <br /> REPUBUC customer No 4-4204-0010317 <br /> SERVICES <br /> L21RS' 07K6i BlYN41 Par4a no 1 of.2 <br /> �Is° I�,�IaI111,I°lIB°n�,i9sf��® °➢Od°1:I1°i,8➢an°°9➢e➢� ate OW15/2019 <br /> H &H ENGINEERING COINSTi Ruc- <br /> MARIA JAIMES ent Charges Total Amount Dace <br /> $1,4134,�3 <br /> 212 INDUSTRIAL ©RIVE $727.:02 <br /> STOCKTON, CA 95206 -- --Please Pay Total Amount Due <br /> Questions? Call 209-466-4492 <br /> 1MPORTA1 V To avoid duplicate pays ents,Please pay the CURREMY CHARGES on each — <br /> invoice.Also,please send the rendftaece with your payment. Thank you? <br /> Date Code IOescriRtiott Refetent:e Race <br /> — At <br /> mawd <br /> OW3 VS Sal-TIMBERITREATEDIOLD —--- Y81:s89470 64.50 8.99TN . <br /> 00 n 060 VS ReWence_5514689 <br /> a <br /> 06/03 VS Vehicle DCC 3364,DCC 43YD <br /> D6/03 VS Conkact:4204122008 <br /> z W03 VS Generator Name: H &H EINGINEERiNG <br /> z D6/03 {1 ENVIRONMENTAL FEE 1 SCB74233 16.25 1.00 16.25 <br /> z <br /> z -16.25/Ticket ENVIRONMENTAL FEE 1 1 <br /> z 060 )l FUEL RECOVERY FEE SC874234 45.54 1.00 45,54 <br /> z (7.06%/Ticket)FUEL RECOVERY FEE <br /> z <br /> z SJ Cnty/AB 939 Fee at 2.00/TIN 0.00 8.99 17.98 <br /> z SJ Cnty/Rd Mitigation Fee at 0.16/T1N 0.00 8.99 1.44 <br /> SJ Cnty/Ern Health Fee at 0.09ITIN 0.00 8.99 0.81 <br /> Material Summary-- <br /> SW-TiMBER/TREATED/OLD 8.99 .35 S <br /> ,u <br /> ACCOUM STATM <br /> Days Days Over!a Days Total Amount Due 5 <br /> uv i P27.02 757.53 0.00 000 $1,4".55 <br /> N <br /> il_l�J 2 5 2019 <br /> y 4,Please return this portion below with your payment.Do not attach check to stub. ;, <br />