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FEE PAYIVENT INFORMATION <br /> Use for corisulmions, reinspections, chargeable complaint inspections and/or taftinistrative hearings at (NVENTOnIED <br /> FACILI I IFS: <br /> 1. Fill out Byes 1 through 7. <br /> 2. Submit to ACCOUNTING OFFICE with fee paid. <br /> ;. The ACCOUNTING OFFICE will receipt payment (Boxes 9 through 151, assign an INVOICE # (Box 8) and forward to <br /> the REHS staff person. <br /> it. Tile assigned INVOICE # will be used with the facility's PROGRAM/WATER RECORD ID on daily activity record for <br /> activities to be charged against this fee. <br /> t'acILlTlf Io # C7U `—f `� Robb I1 # <br /> _ .5 (� `f <br /> FACILITY AOOftESS,' <br /> :.:: ,,:.;:. ........... ;..•.:..�::.::. :.........:.:::. [i V C a:>:�<:::i:et;: :Ss:>s;::+z:>::>:.....:.DATt.:OF....................... ................... .. ......:.......:..:. <br /> ..::...DESIGNATI:o.:,•:.�:.: .:.:::::::::..pfloGBAM:..:.......:. :...::.:::..�.::S.�.:�..�:::::.�:::::::: :::,.�:::::::::::::::::,. . .......,...:.:.:.:.::.:..�::::::. ::.:.::.�::::::::.:�:.�:::::.::::.:.:.:::::,::._::::,,:::.:.�.�: <br /> Ry <br /> ?•t`''';:>•'x:iiii:2iiiii: �C:i::: <br /> EMPLQYEE # E EMENT , <br /> DAfiE of Fit AMOUNT PAYMENT` RLct IPt CHr cK RECVb <br /> PAY►v1ENT AMOUNT <br /> ® 10 t 2 13 1 <br /> ur "iuuTuo rqt cwun�u+a to r«r> <br /> 9'r. 9wf0eaoa Urriclt.' CtfnK Brhrd <br /> I7AT6 641 0ATK <br />'EEPAY.FRM (5/16/94) <br /> WILLIAM HUANG 7072 <br /> SUE HUANG 11-35/1210 <br /> 1908 CHELWOOD WAY 1t. L�19 C 1164 <br /> MODESTO,CA 95355 <br /> ,T NP <br /> PAY r0 THE •75//� <br /> ORDER OF I E'o <br /> DOLLARS <br /> IM Bank of America <br /> Oakmore Plaza Branch#1164 <br /> 1737 Oakdale Road <br /> Modesto,CA 95355 (209)549.8280 <br /> M_ EMO - " - -- <br /> I: 12 L000 3 S81: 707 2 --- 1 1648®®a 7 2S11' <br /> PAYMENT <br /> RECEIVED <br /> 4 <br /> ENVIRONMENTAL HEAL l r' LtIVISI(JN <br />