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** PLEASE CHECK LOOKUP - if good, then Approve QCStatus, else update with correct RECORD_ID (3)
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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A
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AVENA
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AVE 15
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28806
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4200 – Liquid Waste Program
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PR0543484
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** PLEASE CHECK LOOKUP - if good, then Approve QCStatus, else update with correct RECORD_ID (3)
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Last modified
12/22/2021 1:44:44 PM
Creation date
12/22/2021 1:42:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200 – Liquid Waste Program
RECORD_ID
PR0543484
PE
4244
FACILITY_ID
FA0024683
FACILITY_NAME
AMB AG ENTERPRISE
STREET_NUMBER
28806
STREET_NAME
AVE 15
STREET_TYPE
RD
City
MADERA
Zip
95638
CURRENT_STATUS
02
SITE_LOCATION
28806 AVE 15 RD
P_LOCATION
98
QC Status
Approved
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SJGOV\tsok
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EHD - Public
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$ 368.00 _ _ <br />TOTAL DUE this Billing Period <br />_ <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Page 1 <br />INVOICE <br />Return This INVOICE with Your PAYMENT <br />Account ID <br />Facility ID <br />Date Printed <br />AR0046188 <br />FA0024683 <br />9/30/2020 <br />NAVARRO, MARIAH <br />AMB AG ENTERPRISE <br />UK•cZ:RA— 28806 AVE 15 RD <br />MADERA, CA 95638 <br />RE: AMB AG ENTERPRISE <br />28806 AVE 15 RD <br />MADERA, CA 95638 <br />OWNER: AMB RANCH MANAGEMENT <br />Date Health <br />Program Description Amount <br />Invoice # IN0331101 --- Date of Invoice: 10/29/2019 <br /> <br />1 1111111 11011 10 11111 10 11 10 11 11 1111111 11111 1111 1 11111 111111111 11110 11111 11111111 <br />10/29/2019 4244 PUMPER TRUCK $ 184.00 <br />1/15/2020 9994 PERMIT FEE PENALTY $ 184.00 <br />Total for this Invoice 368.00 <br />PAST DUE <br />\dN'304-- pViA.c <br />o Q vw 0 <br />Oft <br />ct .t.10 091-1- zr <br /> O 2-° <br />Please make Checks PAYABLE to: 'El-ID' <br />Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br />at the Rate of 100% of the Base Fee <br />Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br />30 Days after the Due Date <br />60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br />5254.rpt
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