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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E WEBER AVE - 3RD FLOOR ' <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />DON HOLSWORTH <br />OUT WEST AUTO <br />720 E LODI AVE <br />LODI, CA 95240 <br />Page 1 <br />Account ID <br />AR0022800 <br />Facility ID <br />FA0013644 <br />Date Printed <br />Y8/25/2003 <br />RE: OUT WEST AUTO <br />720 E LODI AVE <br />LODI, CA 95240 <br />OWNER: HOLSWORTH, DON <br />Date Health <br />Program Description Amount <br />Invoice # IN0109799 --- Date of Invoice : 7/17/2003 <br />7/17/2003 2220 SM HW GEN <5 TONS/YR <br />7/17/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br />SEUG' 0 NO N 0 T I C E <br />$ 200.00 <br />$ 17.50 <br />Total for this Invoice $ 217.50 <br />Payment Due Date 8/16/2003 <br />TOTAL DUE this Billing Period $ 217.5 <br />P SCE vEC� <br />R <br />S� at j�NEA � � jNp1V1510� <br />EN�1ROr�nnFN;,a <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 />