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SAN JOAQUIN COUNTY Page 1 <br /> ENVPitUNN)ENTAL HEALTH DEPART' NT <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0018042 <br /> Facility ID FA0011042 <br /> LOMMEEMMOMMEENNIN <br /> Date Printed 3/27/2003 <br /> <br /> <br /> MANTECA, CA 95337 <br /> OWNER : ASH QADDOURA <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0103956—Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 85.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this Invoicel $ 302.50 <br /> Payment Due Date 3/29/2003 <br /> TOTAL DUE this Billing Period $ 302.50 <br /> PAYMENT <br /> RECEIVED <br /> APR 3 2003 <br /> SANJOAQUIN COUNTY <br /> PUBLICO HEALTH SERVICES <br /> EWRPNI,AEATM NFAITH D!VISION <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 /> 5255.rpt <br />