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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMr T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID nRoo,s,2a <br /> FacilityID FA0009124 <br /> LMEMMOMMONEEMM <br /> Date Printed 1126/2007 <br /> GEWEKE FORD MERCURY JEEP EAGLE RE : GEWEKE FORD MERCURY JEEP EAGLE <br /> PO BOX 1210 1045 S CHEROKEE LN <br /> LODI, CA 95241 LODI, CA 95240 <br /> OWNER : GEWEKE, DARYL <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0156435---Date of Invoice: 1/2512007 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIVIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIII <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/2512007 2244 2007 HAZMAT FEE $ 330.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 560.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 560.0 <br /> PAY T <br /> AC"OUNT# 1'7 ? S RECEIVED <br /> UNIT/CTL # «D '1 9 200➢ <br /> P.O. # - IN COUNTY <br /> AMOUNT Sb V ��^ ENVIRONMENTAL <br /> FJ�TF D PARTMENr <br /> APPROVED BY /(YITL <br /> (punt) <br /> DATE EXPNSD a- I — D ' _ <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 wil I 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 /> 52i4 rpt <br />