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ZV4N �VMVVl11 bvV,i , i rVO1_ll. nCMLIn JFRV1'-Ca [epor[ 15255 <br /> tNVI', ONMENTAL HEALTH DIV--ION St. 'ement Printed : 07/22/96 <br /> .304 E WEBER AVENUE - 3RD'iOOR <br /> PO BOX 388 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> = rn c;, <br /> TO : SOUZA REALTY & DEVELAST <br /> D10E 10TH ST FoAccount # 0009397 <br /> TRACY , CA 95376 <br /> WE WOULD APPRECIATE YOUR <br /> ATTN : MICHAEL SOUZA PAYmW TODAYI Facility ID 006798 <br /> RE : SOUZA PROPERTY <br /> FABIAN & LAMMERS RD TRACY <br /> PLEASE RETURN a COPY of THIS STATEREIIT vith YOUR PATNENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # OIS434 -- Date of Invoice: 11/17/94 <br /> 11/18/94 PAYMENT $-390 . 00 <br /> 11/15 /94 2953 REPORT REVIEW 1 . 5 INFURNA $117 . 00 <br /> 11/16/94 2953 CONSULTATION 1 . 0 INFURNA $78 . 00 <br /> 11/16/94 2953 OT REPORT REVIEW 1 . 1 INFURNA $128 . 70 <br /> 11/17/94 2953 REPORT REVIEW 2 . 3 INFURNA $179 . 40 <br /> 11 /13/94 2953 CONSULTATION 0 . 3 INFURNA $23 . 40 <br /> 12/02/94 2953 CONSULTATION 0 . 5 INFURNA $39 . 00 <br /> 12/07/94 2953 REPORT REVIEW 1 .0 INFURNA $78 . 00 <br /> 12/23/94 2953 FIELD CONSULT 1 . 5 INFURNA $117 . 00 <br /> 12/27/94 2953 REPORT REVIEW 0 . 8 INFURNA $62 . 40 <br /> 02 /13/95 PAYMENT $-432 . 90 <br /> 01/19/95 2953 FIELD CONSULT 1 . 1 INFURNA $85 . 80 <br /> 02/28/95 2953 REPORT REVIEW 0 . 9 INFURNA $70 . 20 <br /> 03/02/95 2953 REPORT REVIEW 4 . 1 INFURNA $319 . 80 <br /> 03/03/95 2953 CONSULTATION 0 . 7 INFURNA $54 . 60 <br /> 03 /06/95 2953 REPORT REVIEW 1 . 1 INFURNA $85 . 80 <br /> 03/07/95 2953 REPORT REVIEW 3 . 0 INFURNA $234 . 00 <br /> 03/09/95 2953 CONSULTATION 1 . 3 INFURNA $101. 40 <br /> 03/01/95 2953 REPORT REVIEW 6 . 0 INFURNA $468 . 00 <br /> 03/09/95 2953 REPORT REVIEW 1 . 8 INFURNA $140 . 40 <br /> ------------------------------------- <br /> Total for this invoice: $1,560 .90 <br /> Payment PAST DUE <br /> If this IAVOICE has been Paid, Please Disregard this xotice . . . poral), <br /> CExQ4q!' <br /> F S for SERVICE vill be ASSESSED <br /> PENALTIES vill be ASSESSED an all ANNUAL PERMIT Fe at the rate of 112 of the Service Fie <br /> at the rate of 1112 of the 3ase Fee 31 days after the Payment DOE DATE <br /> 31 days after the Payment DUE GATE. and EACH 31 days thereafter. <br /> TOTAL DUE this Billing Period: ;1,560_80 <br /> Please Hake CHECKS PAYABLE to: P H S / E H 0 <br /> $0 . 00 $0 . 00 $0 . 00 $0 . 00 ;1 ,560 .00 $1 , 560 . 00 <br /> I to 31 days 31 to 6i days 61 to 91 days 91 to 121 days } 1Z1 days Account <br /> Balance <br />