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SARI JOAOUIN COUNTY Page t <br /> ENVIRONMENTAL HEALTH DEP_ 'MENT <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> Phone: 209468 <br /> Account ID F AR0000539 <br /> Facility ID FA0000540 <br /> Date Printed 7/24/2002 <br /> LEMMMOMEMENINE <br /> COUNTRYSIDE MINI MART RE : COUNTRYSIDE MINI MART <br /> 14971 N HWY 88 14971 N HWY 88 <br /> LODI CA 95240 LODI CA 95240 <br /> OWNER: BURGIN,GARY <br /> Health <br /> Dale Program Description Hrs Employee Amount <br /> Invoice If IN0097479—Date of Invoice: 7/9/2002 <br /> 7/9/2002 2220 SM HW GEN<5 TONSNR $200.00 <br /> Total for this Invoice $200.00 <br /> Payment Due Date BI 002 <br /> TOTAL DUE this Billing Period 00 00 <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 all SERVICE FEES <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 /> 1x13Ion <br /> PAYS EN-A <br /> REOFIVED <br /> JUL,3 0 2�flL <br /> pUBITN SOHUVjul <br /> ENVIF�NMENtpE HEP,- <br /> 5255.rpt <br />