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JAN JUAUU'1 t�UUN 1 T <br /> ENVIRONMENTAL HEALTH DEPARTM' Page 1 <br /> Y <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003320 <br /> Facility ID FA0003741 <br /> Date Printed 1/26/2007 <br /> BROADBASE INC dba JIFFY LUBE RE : JIFFY LUBE#598 <br /> JIFFY LUBE #598 1130 N MAIN ST <br /> 730 S BECKMAN RD STE B MANTECA, CA 95336 <br /> LODI, CA 95240 <br /> OWNER : FOWLER, DON W <br /> Date Health <br /> i Program Description Amount <br /> Invoice# IN0156689---Date of Invoice: 1/25/2007 1MIT 1111111111$11111 11111 11111 IIIE 11111 11111 11111 111 1111 11111�11111 11 1111 <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 315.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 545.00 <br /> Payment Due Date 2/25/200 <br /> TOTAL DUE this Billing Period $ 545.00 <br /> FEB 2 1 206. <br /> SAM <br /> ouo�i , <br /> ENV/ CO <br /> N�LTR pF qIN A? <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 />