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JVI1W( 111 <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 304 E W--BER AVE - 3RD FLOORSTOCK <br /> Phone: ON,209 46 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003663 <br /> Facility ID FA0004027 <br /> Date Printed 1/30/2006 <br /> HENDRIX FORKLIFT SERVICE INC RE : HENDRIX FORK LIFT INC <br /> PO BOX 5217 103 N E ST <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : HENDRIX, RICHARD <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0142530---Date of Invoice: 1/27/2006 p11pp1p11111p1ppI 11p1p1p11111p1111p111111A IIINp11111 <br /> 1/27/2006 2221 USED OIL ONLY-<5 TONS/YR $ 50.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 74.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 74.00 <br /> a�6-aoA6 <br /> FEB 0 8 2006 <br /> I� RNIROWMERT HEALTH <br /> d PERMIT/SERVICES <br /> 969, 4P44- <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 /> 5254 rpt <br />