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UBLIC HEALI Report #5255 <br /> DIVISION atement Printed : 03 /29 /96 <br /> 04 E WEBER AVENUE — 3RD FLOOR <br /> '0 BOX 388 <br /> TOCKTON , CA 95201-0388 �( — <br /> ccount.ing, Office : 209 468-342 ' <br /> '1 r _- <br /> RADIAN CORP <br /> 10389 OLD PLACERVILLE RD Account # 0010468 <br /> SACRAMENTO , CA 95827 <br /> ATTN : RICHARD VAN DYKE FacLlity ID 007183 <br /> RE : ODRW—TRACY <br /> 25700 CHRISMAN RD TRACY <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> W Service Activity <br /> Date Description Mrs Employee Amount <br /> nvoice M 026719 -- Date of Invoice : 02/20/96 <br /> 01 /29/96 2954 REPORT REVIEW 1 . 0 LAGORIO $78 . 00 <br /> 01 /29/96 2954 CONSULTATION 0 . 5 LAGORIO $39 . 00 <br /> 02 /27/96 2954 FIELD CONSULT 2 . 5 LAGORIO $195 . 00 <br /> 02 /27 /96 436'6 WELL CONSTRUCTION INSPECTION 0 . 5 CARRUESCO $140 . 00 <br /> " ! ! S /96 CORRECTION TO A. CHARGE (REBATCHED TO INV26219 ) $-180 . 00 <br /> Total for this invoice : $312 . 00 <br /> Payment DUE DATE 04/28/96 <br /> VDICE has been Paid, Please Disregard this Notice . . . <br /> r <br /> PAYMENT <br /> MAY 21 1996 <br /> Sp"JV60UIN COUNTY <br /> PUB�IG HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMITS at the rate of 108 of the Service Fee <br /> at the rate of 1008 of the Base Fee 30 days after the Payment DUE DATE <br /> 30 days after the Payment DUE DATE. and EACH 30 days thereafter. <br /> TOTAL DUE this Billing Period : L $312 . 0 <br /> CCOLInt 1-30 Days 31_60 Days 61-90 Days 91-120 Days 121+ us <br /> summary - <br /> 492 . 00 -180 . 00 0 . 00 0 . 00 0 . 00 <br />