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ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 9868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phcie: (209)468-3420 <br /> • COPY Account ID AR0016370 <br /> INVOICE <br /> Facility ID FA0009370 <br /> Date Printed 9/27/2019 <br /> ROSE, DOUG RE : KUSTOM KURVES COLLISION REPAIR <br /> DOUGLAS E ROSE 4 N HOUSTON LN <br /> 4 N HOUSTON LANE LODI, CA 95240-2420 <br /> LODI, CA 95240 <br /> OWNER : DOUGLAS E ROSE <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0327070—Date of Invoice: 9/26/2019 II�IIIII IIIIII IIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIII�IIIIIIIrlllllllll II�II111111111I IN <br /> 9/26/2019 2220 SM HW GEN<5 TONS/YR $ 249.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 298;00 <br /> Payment Due Date 10/27/2019 <br /> TOTAL DUE this Billing Period $ 298.00 <br /> z <br /> ENocr �D 112 � <br /> ViRoN 419 <br /> PERMS%7c k� <br /> ES <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 HMBP 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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />