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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTP AT Page 1 <br /> r <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0018159 <br /> Facility ID FA0011159 <br /> Date Printed 2/25/2005 <br /> SRI/SURGICAL EXPRESS RE : SRI/SURGICAL EXPRESS <br /> <br /> STOCKTON, CA 95206 <br /> OWNER : SRI/SURGICAL EXPRESS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128442---Date of Invoice : 1/24/2005 I(IIIIII IIIIII III VIII(IIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2233 HAZARDOUS WASTE CESQT FACILITY $ 112.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 300.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 636.00 <br /> Payment Due Date <br /> :) <br /> TOTAL DUE this Billing Period $ 636.00 <br /> PAYMENT PAYMEr <br /> RECEIVED RECEIVE-ti <br /> FEB 2 8 2005 FEB 2 <br /> SAN JOAQUIN COUNTY SAN JOAQUIN COUNT`/ <br /> ENVIRONMENTAL ENVAQL)IN OU <br /> HEALTH DEPARTMENT HEALTH DEPARTMEIyT <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 /> 5255.rpt <br />