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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM--'T Page 1 <br /> 304 E W-EBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003320 <br /> Facility ID FA0003741 <br /> Date Printed 3/24/2003 <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# IN0103598---Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 300.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this Invoice $ 517.50 <br /> Payment Due Date 3/29/2003 <br /> TOTAL DUE this Billing Period $ 517.50 <br /> P4 V <br /> Ps"CFIV�� <br /> AfAR 24 2003 <br /> PAI,LdCH 4L COU,N7y <br /> fNl1RGNMFN qaU EAt TH CEq <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 IDES!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.ipt <br />