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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTII T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account AR0016291 <br /> LVEMNOMMMEMMA <br /> Facility ID FA000 2291 <br /> Date Pnnted 1/24/2005 <br /> TED'S WELDING & REPAIR RE : TED'S WELDING & REPAIR <br /> PO BOX 726 8932 E HWY 12 <br /> VICTOR, CA 95253 VICTOR, CA 95253 <br /> OWNER : G WILLIAM BRAUN <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0129043—Date of Invoice: 112412005 I/IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII ILII/III IIIIII VIII/III/III <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 300.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 524.00 <br /> Payment Due Date 2/2312005 <br /> TOTAL DUE this Billing Period $ 524.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR - 4 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 I 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 /> i2:i rpt <br />