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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr .T Page 1 <br /> 600 E MAIN STREET _ <br /> STOCKrON, CA 95202 <br /> Pho,,e: (2139)468-3420 <br /> INVOICE AccountlD AR00 77470 <br /> Facility ID F FA00104 00 <br /> Date Printed 1/28/2008 <br /> lonommommmoma <br /> ELEGANT SURFACES RE : ELEGANT SURFACES <br /> 551 CARNEGIE ST 551 CARNEGIE ST <br /> MANTECA, CA 95337 MANTECA, CA 95337 <br /> OWNER : POLIMENO, JOHN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0170525---Date of Invoice: 1/25/2008 I IIIIIIII I IIIVII VII VIII VIII VIIIVIIIIIII VIIIVIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 315.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 552.00 <br /> Payment Due Date 2127/2008 <br /> TOTAL DUE this Billing Period $ " 552.OQ' <br /> PAYMENT <br /> RECEIVED <br /> MAR - 6 2008 <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 I 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 />