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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART IT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account 10 —AR-0 00 8863 <br /> Facility ID FA 00053 66 <br /> Date Printed 1/24/2005 <br /> BRUCE &JACK <br /> <br /> STOCKTON, CA 95202 <br /> OWNER : LA BERGE, JACK <br /> Date Health <br /> Program Description <br /> Invoice# IN0128893—Date of Invoice: 1/24/2005 IIIIIIIIIIIIIIIIIVIIIIIIIIIIIIIVIIIVIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 100.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 324.00 <br /> Payment Due Date 2/2 31200 5 <br /> TOTAL DUE this Billing Period $ 324.00 <br /> PAYMENT <br /> RECEIVED <br /> JAN 2 S 2005 <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 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 /> :'_i5 rpl <br />