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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR .• <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0004379 <br /> Facility ID FA0002387 <br /> Date Printed 1/24/2005 <br /> KEYSTONE AUTOMOTIVE INDUSTRIES INC RE : KEYSTONE AUTOMOTIVE INDUSTRIES INC <br /> 632 S EL DORADO ST 632 S EL DORADO ST <br /> STOCKTON, CA 5203-3407 STOCKTON, CA 95203 <br /> OWNER : KEYSTONE AUTOMOTIVE IND INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128371 ---Date of Invoice: 1/24/2005 11111111 111111 III VIII VIII VIII VIII VIII VIII VIII VIII 11111111111111 VIII IIII IIII <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HA AT FEE $ 300.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 524.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 524.00 <br /> FPi <br /> PAY M EN- <br /> RECEIVED <br /> FEB 2 2005 <br /> SAN JOAQUIN COUNT <br /> H�THDNMFNTAL <br /> EPARTMENT <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fee 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 /> 52ii.rpt <br />