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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP RTP'— 4T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0023280 <br /> Facility ID FA0013833 <br /> Date Printed 1 1/24/2005 <br /> BRYAN TEVES RE : WILSON & COFFEY APPLIANCES <br /> WILSONCOFF Y APPLIANCES 2617 S EL DORADO ST <br /> 2617 S E DORADO ST STOCKTON, CA 95207 <br /> STOCKT N, CA 95206 <br /> OWNER : PHILLIPS, LEON R <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0130024---Date of Invoice: 1/24/2005 I(IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 111111111 IIII <br /> 1/24/2005 2220 SM HW EN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2399 UNIFIED,PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period 224.00 <br /> RECEIvF G <br /> FEB g 2005 <br /> 30AQUIN COVNN <br /> HEALTH DEPARTMENT <br /> Please make Checks AYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fes For OES/HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Elase 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 /> 52».rpt <br />