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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMW <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID ARoozaasa <br /> Facility ID F FA0016 778 <br /> LUMMMMOMMMMIM <br /> Date Printed 1/28/2008 <br /> Loommmommommmo <br /> BROADBASE INC dba JIFFY LUBE RE : JIFFY LUBE#1478 <br /> JIFFY LUBE#1478 1648 E HAMMER LN <br /> 1471 SHORE ST STOCKTON, CA 95210 <br /> WEST SACRAMENTO, CA 95691 <br /> OWNER : FOWLER, DON W <br /> Date Health Amount <br /> Program Description <br /> Invoice# ING172068---Date of Invoice : 1/25/2008 (IIIIIIIIII I II IIIIIIIIII VIII VI IVIIII IIIIIIII VII VIII VIII IIII 11111111111 IIII IIII <br /> 1/25/2008 2229 GEN 50<250 TONS PERMIT $ 2,149.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 330.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 2,503.00 <br /> Payment Due Date 212711,108 <br /> TOTAL DUE this Billing Period 2,503.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 122008 <br /> SAJOAQUIti COUNTY <br /> ENVIRONMFW j <br /> HEALTH DEPARTMENT <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> ffa <br /> ies will be:' :: <br /> mit Fees For DES/HMMP Fees For,all SERVICE FEES <br /> he Rate ofe Fee Penalteslbe added atthe Rate of 10% Penalties will be added at the Rate of 1030 Days e 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />