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,AN JUAUUIN CUUN 1 Y Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME"T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0022732 <br /> Facility ID FA001 5598 <br /> LMOOMMMMOMMI <br /> Date Pnnted 1/30/2006 <br /> AMERICAN FIRE SYSTEMS INC RE : AMERICAN FIRE SYSTEMS INC <br /> PO BOX 2693 1102 BLACK DIAMOND WAY <br /> LODI, CA 95241 LODI, CA 95240 <br /> OWNER : MOATS, BUDDY <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143265---Date of Invoice: 1127/2006 IIIIIIIIIIIIIIIVIIIVIIIVIIIVIIIVIIIIIIIIIIIIIVIIIVIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2006 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 255.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this lnvolce $ 479.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 479.00 <br /> FEB 2 4 20oo <br /> SAN JOAQUIP,COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPgRTMEW <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 DES/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 /> 5254.rpt <br />