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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME' i <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468.3420 <br /> INVOICE Account ID AR0016876 <br /> Facility ID FA0009876 <br /> Date Printed 2/5/2004 <br /> BLAINE DEJONG'S AUTO WORKS INC RE : <br /> 324 NNE DEJONG'S <br /> AUTO WORKS INC <br /> 324 N CLUFF AVE <br /> VE <br /> LODI, CA 95240 LODI, CA 95240 <br /> OWNER : BLAINE DEJONG'S AUTO WORKS INC <br /> Date Health �; Amount <br /> rk <br /> Program scr, or ---- <br /> Invoice# IN0115823—Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 115.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Totforthislnvoice $ 339.00 <br /> al <br /> Payment Due Date 3/ 04 <br /> TOTAL DUEthis Billing Period 339.00 <br /> PAYMENT <br /> RECEfVED <br /> MAR 3 - 2004 <br /> SAN JOAQUIN COUNTY, <br /> ENVIRONMENTAL t <br /> HEALTH DEPARTMENT <br /> gECMEIVED <br /> WAR <br /> sAN r!V RONIME r '.1.aT <br /> HEALTH DEPAR <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 I 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 />