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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF <br /> 304 E WEBER AVE -3RD FLOOR 1- <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0020236 <br /> Facility ID F FA00123R2 <br /> LMOMMOOMMMMMill <br /> Date Printed 9/11/2003 <br /> AMERICAN MEDICAL RESPONSE RE : AMERICAN MEDICAL RESPONSE <br /> 7575 SOUTHFRONT RD 247 CHARTER WAY <br /> LIVERMORE, CA 94551 STOCKTON, CA 95206 <br /> OWNER : AMERICAN MEDICAL RESPONSE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0103980---Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HAZMAT FEE $ 330.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> 4/15/2003 9987 Haz Mat Program Penalty Fee $ 33.00 <br /> 4/24/2003 9999 PAYMENT ($ 547.50) <br /> 9/15/2003 9990 Debit Adjustment $ 33.00 <br /> 9/15/2003 9997 CORRECTION TO A CHARGE ($ 33.00) <br /> Total for this Invoice $ 33.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 33.00 <br /> PAYMENT <br /> RECEIVED <br /> SEP 112003 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <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 /> 5255 rpt <br />