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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report #5255 <br /> ENVIRONMENTAL HEALTH DIVISION Statpment Printed: 08/22/96 <br /> 304 E. WEBER AVENUE - 3RD *OR <br /> PO B6X"'388 <br /> STOCKTON, CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> r <br /> = rivc ) :L <br /> TO: HOLTZ RUBBER CO r <br /> PO BOX 109 Account # 0005769 <br /> LODI , CA 95240 <br /> ATTN: HOLTZ RUBBER Facility ID 005307 II <br /> RE: HOLTZ RUBBER CO <br /> 1129 S SACRAMENTO ST LODI <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT. <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice # 031403 -- Date of Invoice: 07/25/96 <br /> 08/01/96 PAYMENT $-234 . 00 <br /> 07/24/96 2950 REPORT REVIEW 1 . 0 SASSON $78 . 00 <br /> 07/29/96 2950 FIELD CONSULT 3 . 0 SASSON $234 . 00 <br /> ---------------------- <br /> Total for this invoice: 578.00 <br /> Payment DUE DATE <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> SEP 16 199E <br /> PUBLIC HEAL Ih COUiti TH <br /> SERVIrES <br /> 4 <br /> ENVIRONMENTAL HEAL H DIVISION <br /> 5 <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be. ASSESSED an all ANNUAL PERMIT Fe at the rate of 103 of the Service Fee <br /> at the rate of 1003 of the Base Fee 38 days after the Payment DUE DATE <br /> 30 days after the Payment DUE DATE. and RACE 30 days thereafter, <br /> TOTAL DUE this Billing Period: 578.00 <br /> Please Make CHECKS PAYABLE to: P H E3 / E H D <br /> $78 . 00 0-7-017 . $0 , 00 $0 00 — $0. 00 S 0 $78 . 0 <br /> 8 to 30 days 31 to 60 days 61 to 90 days 91 to 120 days > 120 days Account <br /> Balance <br />