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SAN JOAQUIN COUNTY <br /> ENVi,"'7NMENTAL HEALTH DEPARTN T Page 1 <br /> 600 E RAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0000120 <br /> Lommummmmmomma <br /> Facility ID F FA0000121 <br /> LOOMMOMOMMEMA <br /> Date Printed 2/2/2010 <br /> lumonommonomma <br /> LICENSING DEPT/DURAND, DIANNE RE : CVS/PHARMACY#9261 <br /> CVS/PHARMACY#9261 100 W LODI AVE <br /> <br /> <br /> OWNER : CVSCAR��EMARIE <br /> L.Gt-Yi jDYIUw u-C'. <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0200995—Date ofInvoice: 2/212010 11111111111111111111 fill 111I <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> Total for this Invoice $ 262.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 262.00 <br /> Pf\YN4Ef"JT <br /> RECEIVED <br /> MAR 1 2010 <br /> SAN dOAOUIN COLIN1y <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 OES/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 /> �2;A rpt <br />