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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART • <br /> 304E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0016236 <br /> LMMMEMMMMOMMA <br /> Facility ID F FA0009236 <br /> LMOOMMEMMOMMMA <br /> Date Printed 1/24/2005 <br /> LMOMMUMMONOMMEA <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 /> DateHealth Amount <br /> ^ray ram r)Pcnrioticn <br /> Invoice# IN0129017—Date of Invoice : 1/24!2005 IIIIIIIIIIIIIIIVIIIVIIIVIII VIIVIIVI VIIVIIIVIIIIIIIIIIV IIIIIIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 330.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total forthis Invoice $ 554.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ ,� 554.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 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 DES/HUMP 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 /> iii rpt <br />