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;jAN JUAUUIN GUUN I-Y <br /> ENVIRON�INIEWFAL HEALTH DEP RTM" Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> CORRECTED _ <br /> INVOICE Account ID AR0004379 <br /> Facility ID FA0002387 <br /> Date Printed 2/28/2003 <br /> KEYSTONE AUTOMOTIVE INDUSTRIES RE : KEYSTONE AUTOMOTIVE INDUSTRIES INC <br /> P.O. BOX 6096 632 S EL DORADO ST <br /> STOCKTON, CA 5206-0096 STOCKTON, CA 95206 <br /> OWNER : KEYSTONE AUTOMOTIVE IND INC <br /> Date Health <br /> l P mgram Descripti n Amount <br /> Invoice# IN0103888---Date of Invoice : 2/27/2003 <br /> 2/15/2003 9991 Credit Adjustment ($ 100.00) <br /> 2/15/2003 9991 Credit Adpistment <br /> ($ 17.50) <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 315.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.5 <br /> Total for this Invoice $ 415.00 <br /> Payment Due Date 3/2912003 <br /> TOTAL DUE this Billing Period $ 415.0 <br /> �AyNIE�IT <br /> F ECENED <br /> MA , 19 NO <br /> SpU8L1OHnA H S R p SS10N <br /> ENVIRONMENTAL HEALTH <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added t0 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 ue Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5255.r1,t <br />