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SAN JOA,'UIN COUNTY <br /> ENVIRONZENTAL HEALTH DEPARTM • Page 1 <br /> 304 t WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0028468 <br /> LMENEEMENOWNWA <br /> Facility ID FA0016278 <br /> LMEMMMMMMMMI <br /> Date Printed 2/22/2006 <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# IN0144722---Date of Invoice: 112712006 11111111111111111111 IN 11111111111111111111111111111111111111 IN <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 330.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forthis Invoice $ 554.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $ 554.00 <br /> RECD VSD <br /> FEB 2 2 20ir3 <br /> SAN JOAOUIN,COUNTV <br /> ENVIgpNMENTAL <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 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 /> 5254.rpt <br />