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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTP --IT <br />304 C=WEgER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br /> <br /> <br /> <br />Page 1 <br />Account ID <br />AR0016621 <br />Facility ID <br />FA0009621 <br />Date Printed <br />25/2005 <br />RE: JACK RABBIT <br />471 INDUSTRIAL AVE <br />RIPON, CA 95366 <br />OWNER: EARL M ANDERSON <br />Date Health <br />Program Description Amount <br />Invoice # IN0129237 --- Date of Invoice : 1/24/2005 <br />1/24/2005 2220 SM HW GEN <5 TONS/YR <br />1/24/2005 2244 2005 HAZMAT FEE <br />1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br />I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII <br />VIII IIII <br />$ <br />IIIIII VIII IIII IIII <br />200.00 <br />$ <br />360.00 <br />$ <br />24.00 <br />Total for this Invoice <br />$ <br />584.00 <br />Payment Due Date <br />2/23/2005 <br />$ <br />584.0011" <br />TOTAL DUE this Billing Period <br />PAYMENT <br />RECEIVED <br />FEB 2 8 2005 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br />3enalties will be added to all Permit Fees For OES / 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 thereafte <br />5255.rpt <br />