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SIN COUNTY <br /> MENTAL HEALTH DEPARTMENT � ( Z Page 1 <br /> l.� <br /> rAZELTON AVENUE J t's to <br /> .TON, CA 95205 <br /> ,e: (209)468-3420 <br /> AMENDED Account ID AR0006598 <br /> I�v3 J l � INVOICE <br /> Facility ID F FA0005802 <br /> j <br /> y �C(CI1lG ��43fILGIISI1Date Printed 2/6/2015 <br /> AJ n y 35JSS RE : FCr 6 <br /> c�+ <br /> ARFRI E n^ rN^ 3M0 19750 N LOWER SACRAMENTO RD <br /> Pp ggx 110gc ACAMPO, CA 95220 <br /> 258 <br /> OWNER : ABERLE ACRES INC <br /> Health <br /> Date Program Dasc ipticn Amount <br /> Invoice# IN0260598---Date of Invoice: 1/29/2015 111111111111111111111111 IN <br /> 1/29/2015 1958 HM-Farm Operations $ 18.00 <br /> 1/29/2015 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> i Total for this Invoice $ 266.00 <br /> Payment Due Date 2/28/2015 <br /> Invoice# IN0263882---Date of Invoice: 215/2015 l/ I 1`1( �1111111HI� 111111111111111111111111111111111111111111111111p111111111111111 <br /> 2/5/2015 APSA APSA SURCHARGE q L4 1 $ 26.00 <br /> Total for thisInvoice $ 26.00 <br /> Payment Due Date 31812015 <br /> II V \ ` { 3 <br /> TOTAL DUE this Billing Period $ 292.00 <br /> kc <br /> `-( PAYMENT <br /> RECEIVED <br /> 91 \ MAR 0 2 2015 <br /> lz: <br /> 7c �J-v SAENVOIRONMETT,gL <br /> ICNUNTY <br /> 18' 1VYYY) _ ;/� HEAT-TH DEPARTMENT <br /> iR: <br /> LL <br /> IPF <br /> trot <br /> Nat <br /> rayl <br /> IEh <br /> :OMI 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 thereafte <br />