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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTII <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE A=unt ID AR0020236 <br /> Facility ID FA00 2-3 2— <br /> LEMMMMMMUMMMEN <br /> Date Printed 4/26/2005 <br /> LONOWNEEMEMEMill <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# IN0128466--Date of Invoice: 1/2412005 IIIIIIIIIIIIIIIIIIIIIIIIII�IIIVIIIVIIIVIIIVIII�IIIIIIIIIIIIIIIIIIII�III� <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 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 $ 33.00 <br /> 4/15/2005 9994 PERMIT FEE PENALTY $ 200.00 <br /> 4/15/2005 9997 CORRECTION TO A CHARGE ($ 200.00) <br /> 4/26/2005 9999 PAYMENT ($ 554.00) <br /> Total for this Invoice $ <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 33.00 <br /> PENALTY OWING <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/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 />