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SAN JOAgUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTNfT • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0016236 <br /> Facility ID I FA0009236 <br /> Date Printed 1/30/2006 <br /> BLACKMUN EQUIPMENT LEASING RE : BLACKMUN EQUIPMENT LEASING <br /> PO BOX 6277 1055 S STOCKTON ST <br /> STOCKTON, CA 95206-0277 STOCKTON, CA 95206 <br /> OWNER : THOMAS J BLACKMUN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142624---Date of Invoice: 1/27/2006 1111I11I 1 III VIII VI VIII VIII VIII VI VII VII VIII IN 11111111111 IIII IIII <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/2712006 2244 2006 HAZMAT FEE $ 330.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forthis Invoicel $ 554.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 554.0 <br /> F'AY <br /> REoM EEF D <br /> FEB 0 9 2006 <br /> 'SAN ROVNMCOU <br /> ►EALTN.pPEARTM <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 /> 5254.rp1 <br />