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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1$68 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0033299 <br /> INVOICE <br /> Facility ID FA00 88754 <br /> LMMOMMMMMMMA <br /> Date Printed 11/22/2016 <br /> Imommmmommommma <br /> AMERICAN MEDICAL RESPONSE RE : AMERICAN MEDICAL RESPONSE <br /> 400 FRESNO ST 400 S FRESNO ST <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 <br /> OWNER : AMERICAN MEDICAL RESPONSE <br /> Dale Health <br /> Program Description Amount <br /> Invoice# IN0285336—Date of Invoice: 11121/2016 11111111 111111 III VIII VIII VIII illll 11111 11111 11111 11111 11111/III 111111 VIII IN IN <br /> 11/21/2016 4530 LG QUANITY GENERATOR $ 193.00 <br /> Total for Nis Invoice $ 193.00 <br /> Payment Due Date 1 212212 01 6 <br /> TOTAL DUE this Billing Period $ 193.00 <br /> HEALTH DEPARTMENT Hasler FiR'aT-ci-A�s Muu. <br /> AUTO <br /> UUIN COUNTY I V23i2016 mfag. ,., C, <br /> Hazelton Avenue • aJUU...��.f- <br /> lifomia 95205-6232 <br /> rvice Requested 01"I D'121-',0^_ . <br /> 4 � iV <br /> ENVIRONMENTAL HEALTH <br /> PERMi f/SERV,CES <br /> IF <br /> 8AN'a <br /> 186s' <br /> STO� nai r .i Yf3ai1oSP0111Z4j15 <br /> R TliRN TO F[.i y}E'R <br /> FJWI'C�tkICAN i+tECi CAL -RESPONSE <br /> 3755 WEST LN <br /> STOCKTON CA .9.52.04-243.2 <br /> RETURN TO SENDER <br /> =+SS2i3 si¢z15!F2 illl'ilIII 11111it <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 /> 5154 mt <br />