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SAN JOAOUIN COUNTY PUBLIALTH SERVICES . Page 1 <br /> ENVIRONMENTAL HEALTH DI SION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209468-3420 <br /> INVOICE Account 10 AR0017067 <br /> FA0010067 <br /> Facility ID LommommoommompnA <br /> Date Printed 2/1/01 <br /> STUART BURNHAM RE : Q-LUBE <br /> Q-LUBE 4715 N WEST LN <br /> 3927 MC HENRY AVE STOCKTON CA 95210 20 <br /> MODESTO CA 95356 OWNER: STUART BURNHAM <br /> Health <br /> Date Program Description Hm Employee Amount <br /> Invoice# IN0080366--Date of Invoice: 1130101 <br /> 113012001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 3/3/2001 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to: PHS/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 be added at the Rate of 10 <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> 5pzD ta <br /> �ofi31°° <br /> FEB 13 2001 <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> 5255.rpt <br />