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SAN JOAQUIN COUNTY <br />ENVIRv'NMENTAL HEALTH DEPARTMF <br />3J4 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 />2/5/2004 <br />RE: OUT WEST AUTO <br />720 E LODI AVE <br />LODI, CA 95240 <br />OWNER: HOLSWORTH, DON <br />Health <br />Date <br />t Program Description Amount <br />Invoice # IN0116339 --- Date of Invoice : 2/4/2004 <br />2/4/2004 2220 SM HW GEN <5 TONS/YR $ 200.00 <br />2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br />Total for this Invoice $ 224.00 <br />Payment Due Date 3/6/2004 <br />TOTAL DUE this Billing Period $ 4.00 <br />pAYMENT <br />RECEIVED <br />FEB 2 7 2004 <br />SAN JOAOUIN 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 thereafte <br />�2Si.rpt <br />