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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM Page 1 <br /> 600 E MAIN STREET i <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR 001 22 6— <br /> LUMMMMEMMEEMill <br /> Facility ID —FA 00092 6— <br /> Date Printed 1/29/2009 <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 <br /> Amount <br /> Invoice# IN0164024--Date of Invoice: 1/29/2009 IIIIIIIIIIIIIIIIVIII VIIVIIIIIIIIIIIII VIII VIIIVIIIVIII IIIIIIIIII VIIIIII IIII <br /> 1/29/2009 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 330.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 567.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 567.00 <br /> 7— <br /> PAYME <br /> RNT <br /> ECEIVED <br /> FEB 10 2009 <br /> SAENOAQUIN <br /> IRONM COUNTY <br /> HEALTH DE ART NT <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 />