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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF"T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account 10 1 AR0016876 <br /> Facility ID FA0009876 <br /> Date Printed F 1/30/2006 <br /> DEJONG, BLAINE RE : BLAINE DEJONG'S AUTO WORKS INC <br /> BLAINE DEJONG'S AUTO WORKS INC 324 N CLUFF AVE <br /> 324 N CLUFF AVE LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : BLAINE DEJONG'S AUTO WORKS INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142856—Date of Invoice: 1/2712006 IIIIIIIIIIIIIIIII VIIIVIIIIIIIIIIIIIIIIII VIII VIIIVIII/NII/III IIIIII VIII/III/III <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 115.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 339.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 339.00 <br /> PAYiv?F-NT <br /> RPCPI+✓P-C) <br /> FEB 2 7 206 <br /> SAN JOACUIN CCUNTy <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 /> 5254.rpt <br />