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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTV NT Page 1 <br /> 600 E MAIN STREET _ <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account to - AR0016370 <br /> LMMMUMMEMMMA <br /> Facility ID I FA0009370 <br /> Date Printed 1/28/2008 <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 /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0170178---Date of Invoice , 1125/2008 11111111 Hill IIIII IV IIIII IIIII IIIII 1111111111111111111111111111111 fill IIII <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 255.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forth is Invoice $ 492.00 <br /> Payment Due Date 2/27/2008 <br /> TOTAL DUE this Billing Period $ 2.00 <br /> PAYMENT <br /> RECEIVED <br /> FES 2 2 2008 <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 /> >J rpl <br />