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SAN JOAQUIN COUNT PAYMENT <br /> ENVIRONMENTAL HEALTH DEPARTMENT RECEIVED <br /> .4 2 5 2011 <br /> AUG <br /> �LrFoa� Administrative Hearing Fee Payment Information g,N JOAQUIN COUNT( <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> To Be Filled Out By Staff Only <br /> Facility ID P/RID#: 0 S 3 L 15-f <br /> Account TD#: A R- 0 D 3-7(oq Invoice #: <br /> Facility Name: v4t-� Sa0: '-j&0L,Z) <br /> Facility Address: riI� C SU D 6-1d-nF <br /> Employee#: (o Z2- 5lrvice Code: 552 <br /> Progr-Am Element: t{ Date of Hearing: <br /> To Be Filled Out By Accounting Only <br /> Payment DateFee Amount Mount Paid_ Check#1 ash Reed By <br /> $ ;S?), DC7 $ as'D . 0 (� <br /> EHD 48-02-031 Admin Hearing Fee Payt. <br /> 11/13/2002 <br />