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SAN, JOAQUIN-COUNTY PUBLIC: <br /> EALTH SERVICES <br /> t Report 15155 <br />' ENVIR6hMEf'.TAL HEALTH DIV�ON St ement Printed : 04/23 /97 <br /> 304 E WEBER AVENUE — 3RD FLOOR <br /> STOCKTON , CA 95202 9i <br /> Accounting Office : 209 468--3420 S4 <br /> Gi _ <br /> G! <br /> L' }2/97 <br /> TO : GUARANTY FEDERAL BANK _ <br /> 8333 DOUGLAS AVE ` Account # — 0011759, <br /> DALLAS , TX 75225 <br /> f <br /> i ATTN : <br /> Facility ID 007504 ? <br /> RE : STOCKTON SAVINGS BANK i <br /> 501 W WEBER AVE STOCKTON <br /> 'PUEASE'RETURN a COPYof THIS`STATERENT vith'1"OUR PAYMENT J.. <br /> Service Activity <br /> Date DescriptionHrs :d Employee Amount <br /> � i I <br /> Invoice # 836172 -- Date of Invoice: 03/24/971" <br /> 03/20/97 PAYMENT $-234 . 00 <br /> 03/18/97 2950 REPORT REVIEW 4 . 1 INFURNA $319 . 80 <br /> i 03/19/97 2950 CONSULTATION 0 . 5 INFURNA <br /> 03/21/97 2950 REPORT REVIEW 0 $39 . 60 <br /> . 7 INFURNA $54 . 60 <br /> 03/22/97 2950 OT FIELD CONSULT 3 . 0 INFURNA <br /> 03/24 /97 2950 REPORT REVIEW $351 . 00 <br /> 0 . 4 INFURNA $31 . 20 <br /> ------ ---------- —_—_--- <br /> Total for this invoice : — 561.60 � <br /> i Payment DUE DATE 05/24 C <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> e , <br /> 1 IS <br /> x! <br /> ._ - ... ... .. v ... ... --... -_..r',t .. _ �- _ a 4�...-wa".i�Iw►ev- e.-. ... ..+ww-W^ - *+E <br /> y I 4 <br /> iC <br />+L g <br /> y <br /> PENALTIES for all.IFEES for SERVICE will be ASSESSED + <br /> PENALTIES will he ASSESSED on all ANNUAL PERMIT Fe at the rate' of 11Y of the Service Fee <br /> at the rate of 111% of the Base Fee 31 days after the Payment DUE DATE <br /> 31 days after the Payment DUE DATE. ` and EACH 31 days thereafter. <br /> TOTAL DUE this Billing' Period: #561 .60 <br /> Please Make CHECKS PAYABLE to: <br /> K <br />