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")HIV JUAWUIIV %,UUIV I T <br /> ENVIRONMENTAL HEALTH DEPARTME Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> <br /> AccountlD AR0003380 <br /> Facility ID FA0003795 <br /> Date Printed 1/30/2006 <br /> LIBERTY RURAL FIRE DISTRICT RE : LIBERTY RURAL FIRE DISTRICT <br /> 24124 N BRUELLA RD 24124 N BRUELLA RD <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 <br /> OWNER : LIBERTY RURAL FIRE DISTRICT <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142719---Date of Invoice : 1/27/2006 11111111 U111 111 111 11111 11111 11111 11111 11111/111 11111 11111 1111 111111 11111 IN IN <br /> 1/27/2006 2220 SM HW GEN <5 TONSNR $ 200.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 224.00 <br /> RECEIrv�-D <br /> FEB 2 2 2006 <br /> SAN JOACUI�, <br /> COUNTYENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />