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SAN jC-4dUIN COUNTY Page I <br /> :iNMENTAL HEALTH DEPARTME� <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 _ <br /> 'NVO'CC Account ID R0004177 <br /> G Facility ID F FA000449 <br /> Date Printed F 2/5/2004 <br /> RO LAB AMERICAN RUBBER CO RE : RO LAB AMERICAN RUBBER CO <br /> PO BOX 450 8830 W LINNE RD <br /> TRACY, CA 95378-0450 TRACY, CA 95304 <br /> OWNER : RO LAB AMERICAN RUBBER CO INC <br /> I Health Amount <br /> Date, Program Description <br /> Invoice# IN0115462---Date of Invoice: 2/4/2004 $ 1,568.00 <br /> 2/4/2004 2227 GEN 5<25 TONS PERMIT $ 390.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 24.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC S TATE SERVICE FEE <br /> Total for this Invoice $ 1,982.00 <br /> Payment Due Date 3/612004 <br /> TOTAL DUE this Billing Period L$ =1,982.00 <br /> PAYMENT <br /> RECEIVE® <br /> MAR 5 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 /> For all SERVICE FEES <br /> Penalties will be added to all Permit Fees For OES I HMMP Fees penalties will be added at the Rate of 10% <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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> �15j.rpt <br />