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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTWST Page 1 <br /> 600E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccounIID FA00005769 <br /> Facility ID FA000 3307 <br /> LUMMMWANMEMMM <br /> Date Printed 1/28/2008 <br /> LEMMINNOMMEMMA <br /> HOLZ RUBBER CO RE : HOLZ RUBBER CO <br /> PO BOX 241002 1129 S SACRAMENTO ST <br /> LODI, CA 95241-9502 LODI, CA 95240 <br /> OWNER : HOLZ RUBBER CO INC <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0170087--Date of Invoice: 1125/2008 I IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 111111111 IN <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 555.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 792.00 <br /> Payment Due Date 2/2712008 <br /> TOTAL DUE this Billing Period <br /> PAYMENT <br /> RECEI\/Pn <br /> F E;3 4 2008 <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 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 /> 5254.rpt <br />