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SAN JOAQUIN COUNTY _ <br /> ENVIRONMENTAL HEALTH DEPART • Page I <br /> 304 E WEBER AVE - 3RD FLOOR !!�� <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0025455 <br /> Facility ID F FA00149 99 <br /> Date Printed 1/24/2005 <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 /> L Program Description Amount <br /> Invoice# IN0130117—Date of Invoice: 1/24/2005 IIIIIIIIII VIIVIIIVII VIIIVIIIIIIIIIIVIIVII IIIIIIII VIII IIII IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total forthis Involcel $ 224.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 224.0 <br /> PAYMENT <br /> RECEIVED <br /> FEB 4 2005 <br /> SAN JOAQUIN COUNTY <br /> HEAL RONMENTDEPARTMEN <br /> HT <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 />