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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTIII IT Page 1 <br /> 304E WEBER AVE 2 RD FLOORSTOCKv <br /> Phone: ON,209)CA 95202 <br /> Phone: (209)468.3420 <br /> INVOICE Account ID F A—ROO-16370 <br /> Facility ID F FA0009370 <br /> Dale Printed F 4/4/2003 <br /> INEEMEMMEMEMMMA <br /> KUSTOM KURVES COLLISION REPAIR 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 /> Date Health <br /> Program Description Amount <br /> Invoice# IN0103431 —Date of Invoice: 2127/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 PACT TRANSFER RECORD-OES $ 255.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> 4/4/2003 9999 PAYMENT ($ 427.50) <br /> Total for this Invoicel $ 45.00 <br /> Payment Due Date 3/2912003 <br /> TOTAL DUE this Billing Period $ 45.00 <br /> i <br /> REC E ET- <br /> APR � 4 2003 <br /> C; <br /> SAN JUAC:I�N OIN1 <br /> EN\^.F'v^dd <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 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 Rale of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Dale and each 30 Days thereafter <br /> 5255.tpt <br />