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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTIII., Page 1 <br /> 304 E WEBER AVE -3RD FLOOR ./ <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR000 8863 <br /> LWOMMMOMMMMMA <br /> Facility ID I FA0005396 <br /> Date Printed 1 4/18/2003 <br /> LEMMUMMMMWOMMA <br /> BRUCE &JACK AUTOMOTIVE RE : BRUCE &JACK AUTOMOTIVE <br /> 12 <br /> , CA 95202 <br /> OWNER : LA BERGE,JACK <br /> Date Health <br /> Program Description Amount <br /> Invoice# INO103269—Date of Invoice: 2127/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 PACT TRANSFER RECORD-OES $ 100.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> 4/15/2003 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/18/2003 9999 PAYMENT ($ 317.50) <br /> Total for this Invoice $ 10.00 <br /> Payment Due Date 3/29/2003 <br /> TOTAL DUE this Billing Period $ 10.00 <br /> PAYMENT <br /> RECEIVED <br /> APR 2 5 2003 <br /> SAN JOAOUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <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 DES 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 />