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SAN JOAQUIN COUNTY <br /> 2 <br /> < ENVIRONMENTAL HEALTH DEPARTMENT <br /> Administrative Hearing Fee Payment Information <br /> To Be Filled Out By Staff Only <br /> Facility IDP/RD ID#• SZ. 38 L 0 Gp <br /> Account ID#: NbodUn 9 Invoice#: oa`Qp� <br /> Facility Name: MV& rn 6'b/-, Qj�' <br /> A—EmFacility Address: 2r30", Cc,,4 <A— <br /> Employee <br /> loyee#: i�,P CStdtb Service Code: <br /> Program Element: U 1a t Date of Hearing: 7/(0[11.0 <br /> To Be Filled Out By Accounting Only <br /> Payment Date Fee Amount Amount Paid Chec /Cash Rec'd Sv <br /> - -7 1 (, [ 1� $ - -W�, <br /> EHD 48-02-031 Admin Hearing Fee Payt. <br /> 11/13/2002 <br />