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SAN JOAQUIN COUNTY <br /> ENVIRCAMENTAL HEALTH DEPARTM� • Pzge 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> ST:OCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID F AR0005769 <br /> Facility ID F FA0005307 <br /> Date Printed F 2/5/2004 <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 /> Health <br /> Date Program Desorption Amount <br /> Invoice# IN0115470--Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN<S TONS/YR $ 200.00 <br /> 2/4/2004 2231 HAZARDOUS WASTE PBR FACILITY $ 717.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 600.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 1,541.00 <br /> Payment Due Date 3/6/ 004 <br /> TOTAL DUE this Billing Period $ 1,541.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR 5 2004 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PAYABLE to: 'EHD' — Retunn 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 /> _.rpt <br />