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SAN <br /> ,OIL.00AL HEALTH DISTRIC: <br /> 1.161 0 1 ton Ave. . P,0, Box ._1009 0 0. <br /> r , <br /> 209) 468-342S <br /> Jcigi Khanna, M.D. , Health Of T i[er <br /> CITY <br /> i_tf" TRACY rVi i-Y OF TRACY BOYD CR <br /> iriw) K*S. iR;(KI-Y BLVD <br /> .Billing St-%ati►me-i't• F .w 198'_-'8'_-' F-'E:•.NT i.t•, l a,: F iat i l i ty . <br /> Statement. elate , arivary 1 , <br /> PErPM?nt• Due D-RteFFAFf'TLJ8T ] , <br /> t:Cttl_aii-;r:r Nurrber i 0001 <br /> MIA"IL FEES DUE 00 <br /> Ni_)TES: <br /> �IeaIth Dist:'ict. cif arty <br /> cor s ec.a.I n co- ,.i EtrigFes <br /> nece5s-afy . '+ou;� re.�roit. wi11 <br /> tie Iffai.ied upon recespt• tf•t <br /> payment and a.piprov ai of <br /> }CcCiIit•Y. <br /> Return payment ci l i.tn-4 w i t.•}j cirie <br /> coy of th:5 st•aterlierit toy <br /> ENVIRONMENITAL HEALTH PE,`�ifTi,3'El Vie-­­ <br /> • 1 OCK iT-IN, C"A 96,2201 <br /> ren a.a L•Ji,ff.'s will tie ai.-JiJe l ai iz.r <br /> duE <br /> K days - 10()% of Base Fee <br />