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SAM J00QUIhd?�C0UNTY PUBLIC 'HEALTH SERVICES Report #5255 <br /> ENk4+IRON,M NTAL HEALTH 019ION <br /> 4451 _:SA JOAQUIN STREE <br /> PO .BOX -3.88 <br /> STOC� CA 95201-0368 t b <br /> Acco ing office : 209 468-0340 <br /> t:: EJ• cro t"- 1 <br /> J ` <br /> TO : TRACY CITY PUBLIC WORKS <br /> 560 S TRACY BLVD LAccount # 0003080 <br /> TRACY , CA 95376 <br /> ATTN : TRACY CITY BOYD SERVICE CR Facility ID 003502 <br /> RE : TRACY CITY PLJBLIC.-WORKS ... Bii.ling. Date.: 01/11 /95 <br /> 560 - S TRACY BLVD TRACY <br /> PLEASE 'RETURN THIS STATEMENT WITH YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # 016814 -- Date of Invoice: 01/11/95 <br /> 01 /11 /95 2380 Underground Tank Permit Fee 14201 $170 . 00 <br /> 01/11/95 2380 Underground Tank Permit Fee lr{� Ipz $170 . 00 <br /> 01 /11/95 2380 Underground Tank Permit Fee14.2 1D3- -- <br /> -_____ ______________ $170^00 <br /> Total for this invoice : $510.00 <br /> If this INVOICE ha-s been Paid , Please Disregard this Notice . <br /> and DEDUCT)) the-,, Amount Paid from the TOTAL DUE <br /> ,. <br /> PAYMENT <br /> RE <br /> } M <br /> JA i ty;t <br /> $AN :OA(Q)"N.00U'N1'*r°b <br /> PUBLIC HEALTH SERVIGrg <br /> ENVIRMWNT4 KAM DIVITON <br /> Penalties will be added on all PERMIT 'FtES <br /> at the rate of 100% of the Base Fev <br /> 60 days after the invoice date . <br /> For all SERVICE FEES penalties will <br /> be added at the rate of 10% <br /> 60 �ays past the, invoice date ,and <br /> o a-c h--3 0; dk y ,t b e a <br /> TOTAL DUE this Billing Period: $510- 00Y <br /> Account Days 33 -60 Days 61-90 D 91-120 Days 121+ Plus <br /> Summary _.._.._ .�. <br /> 510 . 00 0 . 00 0 . 00 0 . 00 0 , 00 <br />