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SAN JOAQLAN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STO 95202 COPY <br /> Phone:e: (209(209)46 468-3420 <br /> INVOICE ACountID AR0028468 <br /> Facility lD FA0016278 <br /> Date Printed 1/26/2007 <br /> BROADBASE INC dba JIFFY LUBE RE : JIFFY LUBE#1478 <br /> JIFFY LUBE#1478 1648 E HAMMER LN <br /> 730 S BECKMAN RD STE B STOCKTON, CA 95210 <br /> LODI, CA 95240 <br /> OWNER : FOWLER, DON W <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0158504---Date of Invoice : 1/25/2007 1 II lI III II I V I VIII V I VIII V II VI VII VIII VI 11111111111111111111111 <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 330.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE S 24.00 <br /> Total for this Invoice $ 560.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period <br /> PAYMENT <br /> RECEIVED <br /> FEB 21 20b/ <br /> 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 I 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 />