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ENVIRONMENTAL HEALTH DEPARTME Nage 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 COPY <br /> 3 INVOICE A=unt IDR:0002725 <br /> Facility IQ FA0003160 <br /> Date Printed 5/28/2008 <br /> ADAMS,JIM RE : RIVERSIDE MOBILE: HOME PARK YP ` <br /> RIVERSIDE MOBILE HOME PARK 13955 W WALNUT GROVE RD <br /> 14001 W WALNUT GROVE RD WALNUT GROVE, CA 95690 <br /> WALNUT GROVE, CA 95690 <br /> OWNER : ADAMS, JIM <br /> Date Health <br /> Program Description <br /> Amount I <br /> Invoice# IN0176580—Date of Invoice: 5/27/2008 IIIIIIII Ilfllllfllllllllllllllllllllf IIIIIIIIIIIIIIIIIIIIIIIIIillillllllllllllllllllf <br /> 5/27/2008 4242 WASTE WATER TX PLANT $ 470.00 <br /> 5/27/2008 4622 25-99 SERVICE CONNECTIONS(CWS) $ 516.00 <br /> I <br /> Total for this Invoice $ 986,00 Jj <br /> Payment Due Date 6/27/2008 <br /> d <br /> r <br /> TOTAL DUE this Billing Period $:4 <br /> 986.00 <br /> t <br /> w <br /> f <br /> PAYMEN-T- <br /> SAN JC)AQU;N CCOUNTY <br /> Ei�JVIRplvMEiVTgt., <br /> HEALTH DEP'APTMENT <br /> If }� <br /> Please make Checks PAYABLE to: 'EHD' – Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For oES 1 HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5?54 mt <br /> } <br />