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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTJW Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0003535 <br /> Facility ID F FA0003930 <br /> LWOMMEMEMMMMMMIM <br /> Date Printed F 1/24/2005 <br /> LMMMMMMMMMENNOMME <br /> KING ISLAND RESORT RE : KING ISLAND RESORT* <br /> 14900 W HWY 12 11530 W EIGHT MILE RD <br /> LODI, CA 95242 STOCKTON, CA 95219 <br /> OWNER : WESTRECINC <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0129286---Date of Invoice: 1/24/2005 IIIIIIIIIIIVIVIIVIIIVIIVIIVIIVIVIIVIIIIII IIIIII IIIIIIIII IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 285.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 509.00 <br /> Payment Due Date 2/2312005 <br /> TOTAL DUE this Billing Period $ ' 509.00 <br /> -C:�7 <br /> PAYMENT <br /> RECEIVED <br /> FEB 10 '�U' <br /> SAE JOAQUIN COUNTY <br /> I. <br /> HEALTH DEPARTMFtuT <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 /> 5255.rpt <br />