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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTV-NT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR — — <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0020236 <br /> LUMMMUMMMMEMM <br /> Facility ID FA0012382 <br /> Date Printed 1/30/2006 <br /> AMERICAN MEDICAL RESPONSE RE : AMERICAN MEDICAL RESPONSE <br /> 215 CAMPUS WAY 247 CHARTER WAY <br /> MODESTO, CA 95350 STOCKTON, CA 95206 <br /> OWNER : AMERICAN MEDICAL RESPONSE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143176---Date of Invoice: 1/27/2006 11111p11111111pp11p11Hill pIIIpI <br /> 1/27/2006 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 330.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice I $ 564.00 <br /> Payment Due Date 3/112008. <br /> TOTAL DUE this Billing Period $ 854.00 <br /> Fleet - Valle <br /> Ven r: <br /> Busines Unit: 0.60.-!L.2 7 O <br /> Amount c <br /> Appr al <br /> App val <br /> 414 <br /> SAN✓O j <br /> 0111/1QU/^ <br /> 0oMFivT�n;71 <br /> Qq Mc4 <br /> err <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 />