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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM(W • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKPhone: ON,209 46 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0017389 <br /> Lonommmmommma <br /> Facility ID FA0010389 <br /> Date Printed 1/30/2006 <br /> Iffmomommmmmmmmom <br /> WESTERN RADIATOR SVC OF LODI RE : WESTERN RADIATOR SVC OF LODI <br /> 1780 E ROOSEVELT ST 12 S CLUFF AVE <br /> STOCKTON, CA 95205 LODI, CA 95240 <br /> OWNER : TERALT INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143017---Date of Invoice: 1/27/2006 IIIIIIIIIIIIIIVIIVII VIIIVIIVIIIVIIIIIIIIIIVIIIIIIIIIIVIIIIIIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 255.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invo[cel $ 479.00 <br /> Payment Due Date 3/142" <br /> TOTAL DUE this Billing Pcriod $ /q7g, <br /> PAS V`r f•i i <br /> RECEIVED <br /> FEB 2 8 200D <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 DES/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 /> 5254.rpt <br />