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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF"T Page 1 <br /> 30,S E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID I AR0023280 III <br /> Facility IDFA0013833 <br /> Date Printed 2/5/2004 <br /> BRYAN TEVES RE : WILSON & COFFEY APPLIANCES <br /> WILSON & COFFEY APPLIANCES 2617 S EL DORADO ST <br /> 2617 S EL DORADO ST STOCKTON, CA 95207 <br /> STOCKTON, CA 95206 <br /> OWNER : PHILLIPS, LEON R <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0117474---Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW C EN<5 TONS/YR $ 200.00 <br /> 2/4/2004 2399 UNIFIED ROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ '224.00 <br /> 1 <br /> MEN <br /> UN <br /> SAN JOAQUtME4o AL'.i <br /> ENVIRON <br /> HATH DEPARTMENT <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 />