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ENVIRONMENTAL HEALTH DIV :ON S ,ement Printed: 12/22/95 <br />304 E WEBER AVENUE — 3RD rLOOR <br />PO BOX 388 <br />ST-OCK -MN, CA 95201-0388 <br />Accounting Office: 209 468-3420 <br />1. ri Nw' c)ii.. c....: <br />TO: MOTEL 6 #278 <br />14651 N DALLAS PARKWAY <br />DALLAS, TX 75240 <br />Account it 0007654_1 <br /> <br />ATTN: MOTEL SIX INC Facility ID 003061 <br />RE: MOTEL 6 4$278 <br />3810 N TRACY BLVD TRACY <br />PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br />Service Activity <br />Date Description <br /> Hrs Employee <br /> Amount <br />Invoice # 024597 -- Date of Invoice: 12/19/95 <br />12/19/95 2409 HOTEL/MOTEL >90 $200.00 <br />Total for this invoice: <br /> <br />$200.00 <br />Payment DUE DATE <br /> <br />01/18/96 <br />If this INVOICE has been Paid, Please Disregard this Notice . . <br />Invoice # 024963 -- Date of Invoice: 12/19/95 <br />12/19/95 3611 PUBLIC POOL/SPA—PRIMARY $220.00 <br />Total for this invoice: <br /> <br />$220.00 <br />Payment DUE DATE <br /> <br />01/18/96 <br />If this INVOICE has been Paid, Please Disregard this Notice . <br />JAN 2 2 i996 <br />PENALTIES for all rtEs for SERVICE will be ASSESSED <br />PENALTIES will be ASSESSED on all ANNUAL PERMITS <br /> at the rate of llt of the Service Fee <br />at the rate of lilt of the Base Fee <br /> 30 days after the Payment DUE DATE <br />31 days after the Payment DUE DATE. and EACH 31 days thereafter. <br />TOTAL DUE this Billing Period: <br />Account <br />Summary <br />— <br />1-30 Days 31-60 Days 61-90 Days 91-120 Days 121+ Plus <br />420.00 <br /> 0.00 0.00 0.00 0.00