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SAN,JOAQUIN COUNTY PUBLIC H- " ',TH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVIS I <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOC TON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0003320 <br /> FacilitylDl FA0003741 <br /> Date Printed 4/24/00 <br /> BROADBASE INC RE: JIFFY LUBE* <br /> JIFFY LUBE* 1130 N MAIN ST <br /> 3990 W YOSEMITE RD <br /> LATHROP CA 95330 OWNER: CORRELL PROPERTIES/DON FOWLER <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0069533---Date of Invoice: 4/19/00 <br /> 4/15/2000 9991 Credit Adjustment -$28.50 <br /> 4/19/2000 2220 SM HW GEN<5 TONSNR $100.00 <br /> 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $81.50 <br /> Payment Due Date 5/24/2000 <br /> TOTAL DUE this Billing Period $81.50\ <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT �\ <br /> Penalties will added to all Permit Fees or all SEKV ICE P EES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> m4y 12( ;m <br /> SAN JOi>QIJIfV COUNTY <br /> P IEi-tt^'-1EAt TH SERVICES <br /> ENWHONIv+NTAL HEALTH DIVISION <br /> 5255.rpt <br />