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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTIOT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKIION,"CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID RA 0017931 <br /> Facility ID FA0010931 <br /> Date Printed 1/24/2005 <br /> NICK LANG & HEATHER MORAL RE : AMERICAN TIRE&AUTO REPAIR <br /> AMERICAN TIRE &AUTO REPAIR 8288 S EL DORADO ST <br /> PO BOX 778 FRENCH CAMP, CA 95231 <br /> FRENCH CAMP, CA 95231 <br /> OWNER : LANG, NICK M &JOHN F, TTEE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128401 ---Date of Invoice: 1/24/2005 1111 11111 1111 111111 111 IN 1111 <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 115.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ '339.00 <br /> Payment Due Date 7 2/2312 <br /> TOTAL DUE this Billing Period $ 339.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 1 1 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />