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i <br /> SAN JOAOUIN COUNTY PUBLIC iLTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209-468-3420 <br /> INVOICE U✓ Account ID AR0004379 <br /> Facility ID FA0002387 <br /> Date Printed 1/31/01 <br /> Diw <br /> e KEYSTONE AUTOMOTIVE INDUSTRIES INC. KEYSTONE AUTOMOTIVE INDUSTRIES INC. <br /> ROBERT E TLEY <br /> 632 S EL DORADO ST <br /> PO BOX 6096 STOCKTON CA 95206 <br /> STOCKTON CA 95206 OWNER : KEYSTONE AUTOMOTIVE IND INC <br /> Health <br /> Date F.0gram. Hrs Employee Amount <br /> Invoice# IN0079358---Date of Inv ice: 1/30101 <br /> 1/30/2001 2220 SM HW OEN<5 TONS/YR $100.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110 <br /> Payment Due Date 12/2001 <br /> TOTAL DUE this Billing Period $110.0 <br /> Please make Check PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 1011%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMENT <br /> RECEIVED <br /> FEB 13 2001 <br /> SAN J&%C ;U��•,!-Y <br /> ENVIRG <br /> 5255.rpt <br />