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SAN JOAOUIN COUNTY PUBLI LTH SERVICES •• Page 1 <br /> ENVIRONMENTAL HEALTH D1 ON <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209465-3420 <br /> INVOICE Account ID IF—AR-00-18 553 <br /> FA0011053 <br /> Facility ID <br /> Date Printed 2/1/01 <br /> CAMILLO(CAM)VALLE RE : CHAMPION <br /> CHAMPION 1220 VANDERBILT CIR <br /> 1301 N EUCLID AVE MANTECA CA 95336 20 <br /> PRINCETON IL 61356 OWNER: GARDNER DENVER INC <br /> Health <br /> L _Date Prograr Descrlptlon Hrs Employee Amount <br /> Invoice# IN0081178---Date of Invoice: 1/30/01 <br /> 1/30/2001 2220 SM HVV GEN<5 TONSNR $100.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 313/2 <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 /> RECEIVEfl <br /> FEB 2 6 20{11 ._ <br /> PUBLICO HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5255.rpt <br />