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cNVIRONNENTAL HErLTH DIVIA N Stat ent printed : 10/21/99 <br /> 304 E WEBER AVENUE — 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Accounting Office : 209 468-3420 <br /> rti ✓ o -1. cc?a <br /> TO : COSTAMAGNA , ERNEST <br /> TA , 262 <br /> BANTA , CA 96304 Account N 0003700 <br /> ATTN : ERNEST COSTAMAGNA Facility ID 004052 <br /> RE : FARM UGT <br /> 18775 S TOM PAINE RD <br /> TRACY <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs, Employee Amount <br /> Invoice N 065090 -- Date of Invoice: 10/20/99 <br /> 09/03/99 2961 REPORT REVIEW 1 . 1 INFURNA $85. 80 <br /> 09/29/99 2951 FIELD CONSULT 5 . 1 INFURNA $397 . 80 <br /> 10/20/99 2951 REPORT REVIEW 1 . 9 INFURNA $148 . 20 <br /> -------------------------------"=---- <br /> Total for this invoice:Payment DUE DATE 11/21/99 <br /> $631:88 <br /> / 1 <br /> If this INVOICE has been Paid, Please Disregard this Notice <br /> For all SERVICE FEES penalties will <br /> .Penalties will be added an all Partite be added at the rate of lit 61 days <br /> at the rate of 111t of the Base Fee 31 past invoice date and each 31 days <br /> days after the due date. thereafter. <br /> TOTAL DUE this Billing Period: 631.8• <br /> Please make Checks PAYABLE to: PHS/EHD <br /> � o'; 11it�IV i <br /> riE%EIVED <br /> NOV 121-W <br /> PAN JOAQUIN COUP:V <br /> PUBLIC HEALTH SEFMCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Z d • W HV29:8 6661-1Z-01 <br />