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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM' Page 1 <br /> 600E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR 0025455 <br /> Facility ID F—FA-00 44919 <br /> Date Printed 2/28/2008 <br /> FELIX JACOBS RE : JAUREGUI BODY SHOP <br /> JAUREGUI BODY SHOP 819 E FREMONT ST <br /> 43 CONNIE CT STOCKTON, CA 95202 <br /> BAY POINT, CA 94565-1576 <br /> OWNER : JACOBS, FELIX <br /> Date Health <br /> Program_ Description <br /> Amount <br /> Invoice# IN0171858--Date of Invoice: 1/25/2008 IIIIIIIIIIIIII IIIVIII VIII IIIIIIIIIIIIIIIIIIIIIIIVIII VIII IIIIIIIIII VIIIIIIIIII <br /> 1/25/2008 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 237.00 <br /> Payment Due Date 2/27/2008 <br /> TOTAL DUE this Billing Period $ 237.00 <br /> SES® TI(,',E <br /> MAP 13 2008 <br /> Er�pERM�TISERVICES H <br /> (P- -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 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 />