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SAN J0AQt)iN COUNTY pUBLIG HEALTH SERV'ICE:S <br /> R„pc,r•W .r.h,,55 <br /> '110NMENTAL HEALTH DIVISICrN Statement Printed : 01 /23 /96 <br /> t± WEBER AVENUE -- 3RD OOR <br /> P E30X 388 <br /> STOCKTON , CA 95201--0388 <br /> Accounting Office : 209 468-3420 <br /> AMi'Y PE'L�:°'VER <br /> TO : UNION OIL SS46421 (WALT S) " <br /> PO BOX 25376 Account # 0003400 <br /> SANTA ANA , CA 92799-5376 <br /> ATTN : 76 PRODUCTS CO , LLC Facility ID 00381 <br /> RE: UNION OIL SS#5421 (WALT ' S )" <br /> 7303 PACIFIC AVE STOCKTON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hr, Employee Amount <br /> Invoice # 025733 -- Date of Invoice : 01/22/46 <br /> 01/22. /96 2360 UST Permit Fee Tank * TA122604 $170 . 00 <br /> 01/22/96 2360 UST Permit Fee Tank # TA12260S $170 . 00 <br /> 01 /22/96 2360 UST Permit Fee Tank # T. . 22606 $170 . 00 <br /> 21 96— <br /> 10 <br /> Total for this invoice : <br /> Payment <br /> DUE DATE: 02./ <br /> If this INVOICE has been Paid, Please Disregard this Notice . <br /> PAYMENT <br /> RECEIVE <br /> FEB 2 21996 <br /> —AN o0AUUH4 "OL!N; <br /> PUBLIC HEALTH S�RVICEt <br /> ENVIRONMENTAL HEALTH DIVISIoN <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESS,. on all ANNUAL PERMITS at the rate of 16% of the Service fee a. <br /> at the rate of 1192 of the Base fee 39 days after the Payment DUE DATE <br /> 31 days after the Payment DUE DATE. and EACH 31 daps thereafter. <br /> TOTAL DUE. this Billing Period: $510 .00 <br />'r Ac 1--30 Daysy 91--120 . y.�Ei =, t <br /> .:31-50 Days 61--90 Days 321-+ Plus <br /> Sul ^ <br /> 510 . 00 0 . 00 0 . 00 0 . c�0 0 . 00 <br />