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a . ... � -1. .LU .,. vv v... . <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />DON HOLSWORTH <br />OUT WEST AUTO <br />720 E LODI AVE <br />LODI, CA 95240 <br />f 6 <br />Page 1 <br />Account ID <br />AR0022800 <br />Facility ID <br />FA0013644 <br />•ems <br />Date Printed <br />7/17/2003 <br />RE: OUT WEST AUTO <br />720 E LODI AVE <br />LODI, CA 95240 <br />OWNER: HOLSWORTH, DON <br />Date Health <br />Program Description <br />Amount <br />Invoice # IN0109799 --- Date of Invoice : 7/17/2003 <br />7/17/2003 2220 SM HW GEN <5 TONS/YR <br />$ <br />200.00 <br />7/17/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br />$ <br />17.50 <br />Total for this Invoice <br />$ <br />217.50 <br />Payment Due Date <br />8/16/2003 <br />$ <br />217.50 <br />TOTAL DUE this Billing Period <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 CES / 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 />