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SAN JOAOUIN COUNTY PUBLIC'*fttALTH SERVICES tee! Page 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209468-3420 <br /> INVOICE Account ID AR0016370 <br /> FA0009370 <br /> Facility ID <br /> Date Printed 5/23/01 <br /> ROSE,DOUG RE : KUSTOM KURVES BODY SHOP <br /> KUSTOM KURVES BODY SHOP 4 N HOUSTON LN <br /> 4 N HOUSTON LN LODI CA 952402420 <br /> LODI CA 95240 24 OWNER: ROSE,DOUG <br /> Health <br /> Date Program Description Hrs Employee _ Amount <br /> Invoice 1f ING079841—Date of Invoice: 1130101 <br /> 4/15/2001 9994 PERMIT FEE PENALTY $100.00 <br /> 5/15/2001 9997 CORRECTION TO A CHARGE -$100.00 <br /> 1/30/2001 2220 SM HIN GEN<5 TONSNR $100.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice 110.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> [AST DUE! <br /> WE WOULD APPRECIATE YOUR <br /> PAYMENT TODAY! <br /> PAYMENT <br /> RECEIVED <br /> JUN 2 1 2001 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5255.rpt <br />