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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF%%T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0 22 2236 <br /> Facility ID FA0012382 <br /> Date Printed4!25/2005 <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# IN0128456—.Date of Invoice: 112412005 VIIIIIIIIIII <br /> 1/24/2005 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 330.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> 3/15/2005 9987 Haz Mat Program Penalty Fee — O Q G $ 33.00 <br /> —Art> n 6P_ za <br /> Total for this Invoice $ �vr`uu- <br /> PAST DUE <br /> SSS. o� <br /> TOTAL DUE this Billing Period $ <br /> I'ENAL TY OWING <br /> APR 2 5 2005 <br /> SA EN�1R EPP�M� <br /> NEp,LTH <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 /> 5255.rpt <br />