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ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE -3RD FLOOR • r P. <br /> STOCKTON, CA 95202 • <br /> Phone: (209)468-3420 <br /> INVOICE COPY <br /> Account ID AR0O25455 <br /> Facility ID FA0014919 <br /> Date Printed 3/27/2007 <br /> FELIX JACOBS RE : JAUREGUI BODY SHOP <br /> JAUREGUI BODY SHOP <br /> 43 CONNIE CT 819 E FREMONT ST <br /> BAY POINT, CA 94565-1576 STOCKTON, CA 95202 <br /> OWNER : JACOBS, FELIX <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0158278---Date of Invoice: 1/2512007 IIIIIIIIIIIIIIIII VIII VIII VIII VIII VIII VIII IIIIIIIIIIIIIII IIII IIIIII VIII IIIIIIII <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 206.00 <br /> $ 24.00 <br /> Total for thts Invoice T-230 00 <br /> Payment Due Date 2125/2007 <br /> TOTAL DUE this Billing Period $ 230.00 <br /> PAYMENT <br /> Ek T u u. <br /> REOE(VED <br /> WEWO :.- t;s;aPs,E,CJegE:yCsjR APR 16 2001 <br /> PAYMENT TODAYI 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 OES/HMMP Fees <br /> For all FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be add dl 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.rp[ <br />