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• "w1V1V1rNIAL HEALTH DEPARTMENT <br /> .1868 E HAZELTON AVENUE Page 1 <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account to AR0030338 <br /> Facility ID FA0017456 <br /> Date Printed 1/26/2017 <br /> IMMUNUMMEMEJ <br /> TRAILER PROZ <br /> MARK ZIMAK <br /> <br /> CAMP, CA 95231 <br /> OWNER : MARK ZIMAK <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0289462—Date of Invoice: 1/26/2017 IIIIIIIIIIIIIIIIIIIIIIIIIII VIII VIII VIIIIIIIIIIIII VIII VIII IIIIOIIIIIIIIIIIIIIIII <br /> 1/26/2017 1921 HMBP-Regular-Primary Location <br /> 126/2017 1922 CERS Processing Fee $ 344-00 <br /> 1/262017 2220 SM HW GEN c5 TONS/YR $ 25.00 <br /> 1/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 226.00 <br /> $ 35.00 <br /> Total for this Invoice $ 630.00 <br /> Payment Due Date 2126/2017 <br /> ---------------------- <br /> TOTAL DUE this Billing PeriOdk $ 630.00 <br /> N�q <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 HMBP Fees <br /> at the Rate of 100%of the Base Fee For all SERVICE FEES <br /> 30 Days after the Due Date Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />