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SAN JOAOUIN COUNTY PUBLI ALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209468-3420 <br /> INVOICE Account ID AR0013267 <br /> FA0007679 <br /> Facility ID <br /> Date Printed 1/31/01 <br /> ORLIN KOEHMSTED RE : DELTA RADIOLOGY MED GRP <br /> DELTA RADIOLOGY MED GRP 11-3,104114f N CALIFORNIA ST*464W3 <br /> A-CU OWN CALIFORNIA ST STOCKTON CA 95204 <br /> STOCKTON CA 95204 OWNER: KOEHAISTE , <br /> W-k4- dam` <br /> Health <br /> pate Program Description Hm Employee Amoumt <br /> Invoice# IN0079274F--Date of InvoiWTONS <br /> 1/30/2001 2220 SM HVV GR a $100.00 <br /> 1/30/2001 2399 U IE C STATE SERVICE FEE $10.00 <br /> {/�Q'`) Total for[his Invoice $110.00 <br /> Payment Due Date 31212001 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks 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 100%,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 2 12001 <br /> SAN JOAQCIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIP0,,r=N':nl I{r,^,i Tli i��IcIHy <br /> 5255.rpt <br />