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11301 WILLSHIRE Boulevard
STATEMENT OF ACCOUNT �' PAGE 1 CITY OF BAKERSFIELD P 0 BOX 2057 BAKERSFIELD, CA 93303 -2057 (661) 326 -3979 DATE: 12/01/10 TO.: VA OUTPATIENT CLINIC 11301'WILSHIRE BL BLG218 RM308 ATTN JEREMY PAY LOS ANGELES, CA 90073 CUSTOMER NO: 3623/3623 TYPE: ES - ENVIRONMENTAL SERVICES ---------------------------------------------------------------------------- CHARGE - - - - -- DATE -- - - - - -- DESCRIPTION REF- NTJMBER DUE DATE ------------------- - - - - -- ---- - - - - -- -- - - - - -- -------- TOTAL AMOUNT - - - - -- 11/01/10 BEGINNING BALANCE .00 SS007 11/10/10 CERS - STATE SURCHARGE 25.00 HM001 12/01/10 HAZ MAT FEE GROUP 1 104.00 RE: 1801'WESTWIND DR HM017 12/01/10 HAZ MAT ANNUAL INSPECTION 96.00 RE: 1801 WESTWIND DR SS001 12/01/10 CA STATE SURCHARGE 24.00 RE: 1801 WESTWIND DR ANNUAL BILL FOR THE FISCAL YR 7/1/10 - 6/30/11. IF RECEIVED IN ERROR•PLEASE CALL .(661)326 -3659 -------- - - - - -- -------- - - - - -- -------- - - - - -- -------- - - - - -- CURRENT OVER 30 OVER 60 OVER 90 249.00 DUE DATE: 12/31/10 PAYMENT-DUE: TOTAL DUE: 249.00 $249.00