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SAN JOAQUIN GOUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTMI& * • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> Phone: 209 46 95202 A COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountID AR0005769 <br /> JAN 31 1007 <br /> /y Facility ID FA0005307 <br /> OV 1 �j�' 3/5— Date Printed F 1/26/2007 <br /> LEEMEEMMMENINNA <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 Amount <br /> Invoice# IN0156443---Date of Invoice: 1125/2007 IIIIIIIIIIVIIIVIIVIIVIIVI VIIIVIIIIIIIIIIIII IIIIII VIII IIIIII <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 555.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forth is Invoice $ 785.00 <br /> Payment Due Date 2125/2007 <br /> 1 <br /> TOTAL DUE this Billing Period $ 785PO <br /> tiri <br /> RECEIVED. <br /> FEB 2 0 2007 <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 />