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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF—T <br /> 304 E WF.:JER AVE - 3RD FLOOR <br /> STC:KTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0016370 <br /> Facility ID FA0009370 <br /> Date Printed 2/5/2004 <br /> KUSTOM KURVES BODY SHOP RE : KUSTOM KURVES BODY SHOP <br /> 4 N HOUSTON LN 4 N HOUSTON LN <br /> LODI, CA 95240 LODI, CA 95240-2420 <br /> OWNER : ROSE, DOUG <br /> Health <br /> Date Program Description _ Amount <br /> Invoice# IN0115635--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 $ 255.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE S 24.00 <br /> Total for this Invoice $ 479.00 <br /> Payment Due Date 316/2004 <br /> TOTAL DUE this Billing Period $ 479.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR 1 - 2004 <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 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 /> epi <br />