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SAN JOAQUIN COUNTY <br /> E,NVIRGNMENTAL HEALTH DEPARTFfT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 AR 2 6 2n <br /> INVOICE Account ID AR0005769 <br /> Facility ID FA0005307 <br /> Date Printed 1/24/2005 <br /> INOWEENNEEMMMMMME <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 : DRYBURGH, JIM <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0129901 ---Date of Invoice: 1/2412005 IIIIII III VII VIII VIIIVIIV VIVI VII VIII IN IIIIII IIIII IIII IN <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 555.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoicel $ 779.00 <br /> Payment Due Date 2123/2005 <br /> TOTAL DUE this Billing Period $ 779.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 18 2005 <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 OES/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 />