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SAN JOAQUIN COUNTY I Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTN r <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA <br /> <br /> lD AR0017815 <br /> Facility ID FA0010815 <br /> Date Printed I 4/23/2003 <br /> COUNTRY CLUB CLEANERS RE : COUNTRY CLUB CLEANERS <br /> 1901 COUNTRY CLUB BLVD 1901 COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 STOCKTON, CA 95204-4821 <br /> OWNER : MICHAEL L DAVIS <br /> Health Amount <br /> Date Program Description -— <br /> Invoice# IN0103894—Date of Invoice 2/27/2003 <br /> 2/27/2003 2220 SM HW EN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 PACT T NSFER RECORD-OES $ 270.00 <br /> 2/27/2003 2399 UNIFIE PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> 4/15/2003 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice $ 514.50 <br /> Payment Due Date 3/29/2003 <br /> ` TOTAL DUE this Billing Period $ 514.50 <br /> THE C' tiREf.h'YEAR <br /> b`ILL 1\10i c I$SU-L UNTIi_ <br /> PAST DUE AP.iOUNTS <br /> A 'AI's ENT <br /> IN FULL REc�NED <br /> W 3 o 2003 <br /> Sp,N jop UU1N COUNN <br /> FUBLIO WEALTH StFiVw�•, <br /> ENVIRONMCNT L pFAITH DIVISION <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 /> 5255.rpt <br />