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f4( } <br /> IaA[V JVAl,1Vf1v %,.VUri 1 T Page 1 <br /> ENVIRONMENTAL HEALTH D <br /> EPE''' <br /> 304 E WEBER AVE -3RD FLSTOCKTON, CA 95202 <br /> Phone: {209)468-3420 Account ID AR0019593 <br /> Facility ID FA0012186 <br /> Date Printed 11/19/2004 <br /> VIRGINIA VALDEZ RE : CHANNEL MEDICAL CENTER <br /> CHANNEL MEDICAL CENTER 701 E CHANNEL ST <br /> PO BOX 779 STOCKTON, CA 95202 <br /> STOCKTON, CA 95201-0779 <br /> OWNER : COMMUNITY MEDICAL CENTERS INC <br /> Date Health <br /> Program Description Amount <br /> nvoice 9 IN0126604--Date of Invoice: 11116/2004 1111111111111111111111IIIIIII111Ii11111111111111111111111IN11111111111I11 HE <br /> 11/16/2004 4557 MED WASTE LIMITED HAULER $ 70.00 <br /> Total for this Invoice $ 70.00 <br /> Payment Due Date 12119/2004 <br /> TOTAL DUE this Billing Period $ 70-00 <br /> ptA MUh BANK OF STOCKTON <br /> N� MINER&SN JQUIN <br /> 533 <br /> STOCKTON,ACALIOFA952U2 90-103 <br /> 1211 <br /> Cf� CHECK DATE <br /> C6 <br /> P.O. Bax 779 12 16 04 71533 <br /> Stockton, CA 95201 <br /> PAY THIS AMOUNT <br /> **$70.00** <br /> PAY EHD <br /> THE 304 E. WEBER AVE —3RD FLOOR <br /> )ER OF STOCKTON, CA. 95202 e <br /> 118071533114 t: 1211010371: 2111100 1.,9less 911'01 <br /> Please make Checks PAYABLE to: 'EHD' - Retum a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For IDES 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 /> 5255.rpt <br />