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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTFO-NT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR y <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0024504 <br /> Facility ID FA0014424 <br /> Date Printed 1/24/2005 <br /> IMMUNNOMMENNEMEM <br /> TRACY VW RE : TRACY VW <br /> 2605 AUTO PLAZA DR 2605 AUTO PLAZA DR <br /> TRACY, CA 95376 TRACY, CA 95376 <br /> OWNER : ISSAC SERGIS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128862--Date of Invoice: 1124/2005 1III1III11I III VII11I1I1IIII IIIIIIIIII VIIIIIII VIII 1111 lip 1111111111 IN IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $II 200.A00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 130.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 354.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 354.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB S 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH 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 /> i2??.rpt <br />