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REMITTANCE ADVICE VEN?j - I° FIG 1. STATE OF CALIFORNIA <br /> siD.ADaO REV.nres� 000001 9'-'OiAE ENCLOSED WARRANT IS IN PAYMENT OF INVOI SHOWN BELOW <br /> DEPT.NO. RP <br /> DEPARTMENT INVOICE DATE INVOICE NUMBED <br /> w INVOICE AMOUNT IND <br /> NORTHERN CALIF YOUTH CEN'T'ER 5471 01/10192 TANK PE:RMOT00 <br /> CLAIM SCHED.NO. <br /> DEPARTMENT ADDRESS <br /> P • o , Box 213004 091.0663 <br /> STOCKTON CA 95213--90 4 <br /> QAN JOAQUIN LOCAL HEALTH <br /> VENDOR PUBLIC HEALTH SERVICES <br /> PO BOX 2009 <br /> STOCKTON CA 9520x. fU <br /> FEDERAL TAX ID NO OR MAN RP TYPE TOTAL REPORTED nun SEE"I'S) TOTAE„ 1360 . 00 <br /> 00 This amount will be reported in accordance with Section <br /> i6041 of the Internal Revenue Code. <br />