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li U1N1 T <br /> ENVIRONMENTAL HEALTH DEPARTMF"IT Page <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR00099 44 <br /> LMMMMMUNINININJ <br /> FacilitylD FA0006977 <br /> Date Printed 8/24/2011 <br /> KOMAL BROS INC RE : 76 EXPRESS TIGER NO 1 <br /> 76 EXPRESS TIGER NO 1 5777 S FRENCH CAMP RD <br /> 5777 S FRENCH CAMP RD STOCKTON, CA 95206 <br /> STOCKTON, CA 95206 <br /> OWNER : KOMAL BROS INC <br /> Date Health <br /> Program Description <br /> -- --- Amount <br /> Invoice# IN0214128—Date of Invoice : 2/4/2011 IIIIIIIIIIIIII IIIVIIIVIII VIIIIIIIIIIIII IIIIIIIIII VIII VIII IIII IIIIII 11111111111 <br /> His Employee <br /> 1/28/2011 2308 198-UST RETROFIT REPAIR PLAN CHECK 1.00 RIVERA $ 122.00 <br /> 2/4/2011 9999 PAYMENT ($ 366.00) <br /> 4/15/2011 2308 198-UST RETROFIT REPAIR PLAN CHECK 0.20 RIVERA $ 24.40 <br /> 6/9/2011 2308 198-UST RETROFIT REPAIR PLAN CHECK 0.20 RIVERA $ 24.40 <br /> 6/28/2011 2308 198-UST RETROFIT REPAIR PLAN CHECK 0.50 RIVERA $ 61.00 <br /> 6/28/2011 2308 298-UST RETROFIT REPAIR INSPECTION 2.00 RIVERA $ 244.00 <br /> 6/30/2011 2308 298-UST RETROFIT REPAIR INSPECTION 2.20 RIVERA $ 268.40 <br /> ` Total for this Invoice $ 378.20 <br /> Payment Due Date 8/26/2011 <br /> SECOND NOTICE TOTAL DUE this Billing Period $ 378.20 <br /> PAYMENT <br /> RECEIVED <br /> AUG 2 9 2011 <br /> s JOAo01N C' <br /> ENVIRONMENTAL <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 /> i4 rpl <br />