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SAS: SOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE �O[py Amount ID AR0041098 <br /> ILUIrJ \l'�/ FacilityID FA0022455 <br /> LMMMMEMMEMNEEN <br /> Date Printed 8/28/2014 <br /> AMERICAN MEDICAL RESPONSE RE : AMERICAN MEDICAL RESPONSE <br /> 400 FRESNO AVE 455 W BEVERLY PL <br /> STOCKTON, CA 95203 TRACY, CA 95376 <br /> OWNER : AMERICAN MEDICAL RESPONSE <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0255782---Date of Invoice: 8/28/2014 IIIIIIII IIIIIIIIIIIIIVIII VIIVIIVIIVIIVIII VIII IIIIIIIII VIII IIII IIII <br /> 8/28/2014 1921 HMBP-Regular-Primary Location $ 255.00 <br /> Total for this Invoice $ 255.00 <br /> Payment Due Date 9/27/2014 <br /> TOTAL DUE this Billing Period $ 255.00 <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <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 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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />