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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM§T r Page 1 <br /> 600 E MAIN STREET . <br /> PTO 95202 COPY <br /> Phone:e: (209(209) 46 46 8-3420 <br /> INVOICE Account ID RR0016236 <br /> Facility ID F FA0009236 <br /> Date Printed F 1/28/2008 <br /> lamommmommommom <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# IN0170123---Date of Invoice: 1/25/2008 IIIIIIII IIIIII IIIIIIIIIIIII VIII IIIIIIIIII VIII VIII IIIIIIIIII IIII IIIIII 111111111 IIII <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 330.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 567.00 <br /> Payment Due Date 2/27/2008 <br /> TOTAL DUE this Billing Period $ 567.00 <br /> PAYME <br /> RECEIVED <br /> FEB 12 2008 <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 /> 5254.rpt <br />