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FORWARD, INC. � � IN VUCE <br /> 1145 West Challer Way <br /> Steckton, CA 95206 Invoice Date 1011512019 <br /> Invoice No 4204-000053821 <br /> REPUBLIC Customer No 4-4204-0010317 <br /> SERVICES <br /> t nmm rcn Ipppn:�� Page No 1 ,of 2 <br /> 1'Ild.li,,,11'11l., ,I�dJl11l�iI'1'�II��'�!"'1'p��'1'I'�IIII Dee Date 11,11412019 <br /> ' U &H1 ENGINEERING CONSTfRUCTJON <br /> MARIA JAIMI=S Current Changes Total Amount Due <br /> 212 INDUSTRIAL DRIVE -- $724.36 ---$1,561-00 � <br /> STOCKT�ON., CA 95206 — — —— <br /> Please Pay Total Amount Due <br /> Billing Questions? Call 209-466-4492 <br /> F <br /> ORTANTH!To ensure your payment is posted to the correct invoice, we need <br /> torn remittance from your invoice. Thank you. <br /> ------- ------ -- <br /> Date Code [Description__----__-- Ref,�ence Rafe Amount <br /> — -- <br /> 101n3 VS SMIt TIMBER/TREATEIa1UL D Y814159W 64.5D 9.3OTN 645.00 <br /> 10/03 VS Reference:M0884 <br /> 10/03 VS Vehicle. DCC 3364,DCC 40YD <br /> 10/03 VS Contract 4204122008 <br /> 10/03 VS Generator Name:H &H ENGINEERING <br /> z 10/03 ENVIRONMENTAL FEE 1 1 <br /> z { SC914265 16.25 100 16.25 <br /> z -16.25/Ticket ENVIRONMENTAL FEE 1 1 <br /> z 10/03 11 FUEL RECOVER`(FEE SC914266 42.18 1.00 42.18 <br /> z (6.54%1 Ticket)FUEL RECOVERY FEE <br /> Z SJ Cnty I AB 939 Fee at 2200/TN �� 0.00 9.30 18.60 <br /> z SJ Cnty i Rd Mitigation Fee at 016/TN 0.00 9.30 1.49 <br /> SJ Cnty/Env Health Fee at 0.09/TN INp 000 930 0.84 <br /> Material Summary-- p <br /> SITU-TIMBERITREATEDIOLD t' ,� <br /> ACCOUNT STATUS <br /> 70 Current 31�9 --- --- <br /> Days over so to Total anrwn,t ode OCT 2 9 2019 <br /> o $1,561.00 I 000 0.00 0.00 $1,561.00 r <br /> ST <br /> y y Please return this portion below with your payment.Do not attach check to stub. y <br /> eC— ----_-----_------------------------------------ <br /> ------------------------------------------------ <br />