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.7HIV JVHt,(UIIV I.VVIV 1 i <br /> ENVIRONMENTAL HEALTH DEP RTMF"T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 COPY <br /> INVOICE <br /> <br /> 2/28/2006 <br /> COUNTRY CLUBLEANERS RE : COUNTRY CLUB CLEANERS <br /> 3307 FAIRWAY DR 1901 COUNTRY CLUB BLVD <br /> STOCKTON, CA 9 204 STOCKTON, CA 95204-4821 <br /> OWNER : KITTO, JEFF <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143098--Date of Invoice: 1 27/2006 I(IIIIII IIIIII III IIIII VIII IIIII VIII VIII IIIII IIIII IIIII IIIII IIII IIIIII VIII IIII IIII <br /> 1/27/2006 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZ AT FEE PLUS 1 YEAR BACK BILLING $ 510.00 <br /> 1/27/2006 2399 UNIFIED P OGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 734.00 <br /> Payment Due Date 3/1/2006 <br /> !P.7Er,ffAwh7%NO 61 N'0TI TOTAL DUE this Billing Period 73,4. <br /> PAYMENT <br /> RECEIVED <br /> MAK 2 0 2006 <br /> SAN JOAQUIl\!COUN!Ty <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PA BLE 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 />