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JAN JUAWUIN WUN 1 T <br /> ENVIRONMENTAL HEALTH DEPARTMF, IT • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR - <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0017931 <br /> Facility ID FA0010931 <br /> Date Printed 1/30/2006 <br /> r: <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# IN0143122---Date of Invoice: 1/27/2006 III'IIII IIIIII III IIIIIIIIII IIIII IIIIIIIIII IIIII IIIIIIIIII IIIII IIII IIIIII 111111111 IN <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 115.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 339.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $- 339.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 1 7 2006 <br /> SAN JOAQUIP!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 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 />