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JAN JUAUUIN UULIN I Y Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTM— 'T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID ARoo1417s <br /> Facility ID FA0007815 <br /> LUMMMMMMOMMA <br /> Date Pnnted 1/30/2006 <br /> <br /> <br /> MANTECA, CA 95336 <br /> OWNER : ESCOBAR, FRANCENE M <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0143419--Date of Invoice: 1/27/2006 I IIIIII IIIIII III IIIII IIIII VIII VIII VIII VIII IIIII IIIII IIIII VIII IIII IIIIII 1111111111111 <br /> IIIIIIIIIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE PLUS 1 YEAR BACK BILLING $ 630.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,649.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ , 1,649.00 <br /> PAYMENT <br /> RECEIVED <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 /> z',4 rpt <br />