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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTP —'AT Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0025410 <br /> Facility ID FA0014884 <br /> ILMMOMMMMUMMi <br /> Date Printed 3/1/2005 <br /> MAIN ST MUFFLER RE : MAIN ST MUFFLER <br /> 3403 E MAIN ST C 3403 E MAIN ST STE C <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : EULALIA PENA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0130104---Date of Invoice: 1/24/2005 IIIIIIIIII VIII IIIIIIIIIIIIIIIIIIIIIIIII VIII IIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIN <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 285.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 509.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 509.00 <br /> 7. a <br /> PAYMENT <br /> €DECEIVED &-5 H <br /> MAR 12005 <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 /> Penalties 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 thereafter <br /> 5255.rpt <br />