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SAN JOAQUIN COUNTY Page1 <br /> ENVIRONM:CNTAL HEALTH DEPARTM T `� <br /> 304 E'4E6ER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Accou�tID AR0005863 <br /> Fa Ixty ID FA0005396 <br /> Date P-nted F 2/5/2004 <br /> LAIMEMEMNEWMEMA <br /> BRUCE &JACK AUTOMOTIVE RE : BRUCE &JACK AUTOMOTIVE <br /> 12 <br /> , CA 95202 <br /> OWNER : LA BERGE, JACK <br /> Date Health Amount <br /> Program De"rpt'o <br /> Invoice# IN0115476--Date of Invoice: 2/412004 <br /> 200.00 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR S <br /> 100.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE S <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE S 24.00 <br /> Total for this Invoice $ 324.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 324.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 13 2004 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMFNTAL <br /> HEALTH DEPARTtv.ENT <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 I 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 />