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SAN JOAQUIN COUNTY <br /> ENVIR9NMENTAL HEALTH DEPARTMI Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0003320 <br /> Facility ID FA0003741 <br /> Date Printed 2/23/2006 <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 /> Program Description Amount <br /> Invoice# IN0142834---Date of Invoice : 1/27/2006 111111111111111$IIE IIIII IIIII IIIII 11111 11111 11111 11111 1111 111111 11111 1111�111 <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 315.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 539.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 539.00 <br /> PAY il, <br /> REC'F=�ly� � <br /> FEB 2 3 2005 <br /> SAN JOAOUIi`;COUNT`! <br /> ENVIRONMENTAL <br /> HEALTH DEPP_RTMENT <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 I 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 />