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OAN JUAWUIN UUUN 1 T <br /> ENVIRONMENTAL HEALTH DEPARTMr: Page ge 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0027290 <br /> Facility ID FA0015758 <br /> Date Printed 1/30/2006 <br /> VAN DE POL ENT INC-PRIMARY RE : VAN DE POL ENT INC-PRIMARY <br /> <br /> STOCKTON, CA 95206 <br /> OWNER : VAN DE POL ENTERPRISES INC. <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0144619---Date of Invoice: 1/27/2006 11111111 111111111 VIII VIII IIIIIIIIII IIIII IIIII VIII VIII VIII 11111111111 <br /> IIII IIII <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 390.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 614.00 <br /> Payment Due Date 3 06 <br /> TOTAL DUE this Billing Period $ 614. <br /> pp,Yl�ll <br /> FEB 2 � 2006 <br /> SAN 3OAQUIPI COUN7`i <br /> ENVIRONME14NAL <br /> HEALTH DEpp.3TMENT <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 /> 5254.rpt <br />