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SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTIMT • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR VF <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR 0018012 <br /> Facility ID F FA00110 2— <br /> Date Printed F 2/5/2004 <br /> PACIFIC COAST INDUSTRIES RE : PACIFIC COAST INDUSTRIES <br /> PO BOX 1081 4101 N HOLLY DR <br /> TRACY, CA 95378 TRACY, CA 95376 <br /> OWNER : CURTIS MARUYASU AMERICAN INC <br /> Date Health <br /> I Progiarn Doscrpton Amount__ <br /> Invoice# IN0116133—Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 360.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Tolal for this Invoice $ 584.00 <br /> Payment Due Date 31612004 <br /> TOTAL DUE this Billing Period $ 584.0 <br /> C <br /> nl rl t', U t or a v �pYMENT <br /> RECEIVED <br /> FEB272004 <br /> SANJOAQUIN 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 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 />