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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME• • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR i I <br /> STOCKTON, CA 95202 1 1(tl Cl 1 <br /> Phone: (209) 468-3420 - 1 <br /> INVOICE AccountlD AR0016439 <br /> Facility ID F FA0009439 <br /> Date Printed 2/5/2004 <br /> AMERICAN TRANSIT MIX- FRENCH CAMP RE : AMERICAN TRANSIT MIX- FRENCH CAMP <br /> 3407 W STUHR RD 899 E ROTH RD <br /> NEWMAN, CA 95360 FRENCH CAMP, CA 95231 <br /> OWNER : JERRY LARSEN <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0115663--Date of Invoice: 2/4/2004 <br /> 2/412004 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 435.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoicel $ 659.00 <br /> Payment Due Date 3 0 <br /> TOTAL DUE this Billing Period $ 659.00 <br /> PAYMENT <br /> �189701172�3� RECEIVED <br /> FEB 2 4 20P4 <br /> -+ SAN JOAOUIN COUNTY <br /> rFB 2004 W ENVIRONMENTAL <br /> 1-0006 <br /> �'/V "' e�N(,�(/Jt HEALTH DEPARTMENT <br /> eZ9Z� <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/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 />