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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR - <br /> STOCKTON, CA <br /> <br /> count ID AR0017815 <br /> Facility ID FA0010815 <br /> Date Printed 5/24/2004 <br /> COUNTRY CLUB CLEANERS RE : COUNTRY CLUB CLEANERS <br /> 1901 COUNTRY CLUB BLVD 1901 COUNTRY CLUB BLVD <br /> STOCKTON, CA 995204 STOCKTON, CA 95204-4821 <br /> OWNER : MICHAEL L DAVIS <br /> nate Health <br /> Program Dcscriptic. Amount <br /> Invoice# IN0116086--Date of invoice: /4/2004 111111111111111111111111111111111111111111111111 IIH IIIIIIIIIIIIIIIIIII <br /> 2/4/2004 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZ AT FEE $ 270.00 <br /> 2/4/2004 2399 UNIFIED ROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> 3/21/2004 9987 Haz Mat P ogram Penalty Fee $ 27.00 <br /> 4/15/2004 9994 PERMIT F E PENALTY $ 200.00 <br /> Total for this Invoice $ 721.00 <br /> PAST DUE <br /> s-oft PAST DUE! TOTAL DUE this Billing Period 721.00 <br /> WE WOULD AP RECIATEYOUR PAYMENT <br /> PAYMENT TODAY! RECEIVE <br /> JUN 2 9 2004 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> &MN"e <br /> YOUR T4HEALTi PERMIT FOH <br /> TCURRENT YEAR <br /> V ILL N: T BE ISSUED UNTIL <br /> PAST DUE/eiv10UNTS <br /> ARE PAID IN FULL ST DUE <br /> [Wingruent charges <br /> Will be forwarded to <br /> COLLECTIONS <br /> in 30 days. <br /> Please make Checks PA ABLE 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 /> 5255.rpt <br />