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SANJOAQUINCOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTV=NT Page 1 <br /> SWE AMAIN STREET 61� <br /> STOCKTON, CA 95202 REC&IEQ copy <br /> Phone: (209)468-3420 <br /> INVOICE 2D06 <br /> AcxountlD AR0016105 <br /> � IO� €iu ERI�M0"is :P <br /> Facility In FA0009105 <br /> Date Printed 1128!2008 <br /> ARBOR CONVALESCENT HOSPITAL RE : ARBOR CONVALESCENT HOSPITAL <br /> 900 N CHURCH ST 900 N CHURCH ST <br /> LODI,CA 95240 LODI, CA 95240 <br /> OWNER <br /> Awe- 1 uT4 CA4E Ss19,.Vjt✓ pJC. <br /> Date Health <br /> Program DestxiPtion Amount <br /> Invoice# IN0171035—Date of Invoice: 1!201200$ 1owl <br /> Else <br /> 010,15..,1 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 270.00 <br /> 1725/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FE $ 24,00 <br /> Tafel cur this Imrolee $ 254.00 <br /> Payment Due Date 2f2712008 <br /> `C TOTAL DUE this Billing Period ; C 294.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR 2 2 2008 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PAYABLE — 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 Rabe of 100%of the Base Fee Penalties will be added at the Rate of 109+ Penalties will be added at the Rats of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 nays after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />