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SAN JOAOUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPA&4ENT • <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> Phone: 209468-3420 <br /> INVOICE Account ID AR0017067 <br /> Facility ID FA0010067 <br /> LMOMOMMOOMMEEM <br /> Date Printed 3/1/2002 <br /> C RAFANAN-A/P RE : JIFFY LUBE <br /> JIFFY LUBE 4715 N WEST LN <br /> 3990 W YOSEMITE RD STOCKTON CA 95210 20 <br /> LATHROP CA 95330 <br /> OWNER: FOWLER,DON W <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0091614--Date of Invoice: 112212002 <br /> 1/22/2002 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $17.50 <br /> 1/22/2002 2220 SM HW GEN<5 TONSNR $200.00 <br /> Total for this Invoice $217.50 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period 217.50 <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 all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will he added at the Rate of 10 <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> ReCEJQL -I- <br /> r <br /> i=E&2 8 2002 <br /> SAN JUA <br /> ini IC li VUjNcEO r <br /> nnaglOPi <br /> 5255.rpt <br />