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SAN JOAQUIN COUNTY Pae 1 <br /> ENVIRONMENTAL HEALTH DEPARTV- AT <br /> g <br /> 304 E'W EBER AVE -3RD FLOOR _ <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account 10 FA—ROO16876 <br /> Facility ID FA0009876 <br /> Date Printed 2/27/2003 <br /> lumommmmommmmom <br /> BLAINE DEJONG'S AUTO WORKS INC RE : BLAINE DEJONG'S AUTO WORKS INC <br /> 324 N CLUFF AVE 324 N CLUFF AVE <br /> LODI, CA 95240 LODI, CA 95240 <br /> OWNER : BLAINE DEJONG'S AUTO WORKS INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0103619--Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 115.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this lnvolce $ 332.50 <br /> Payment Due Date 3/2912003 <br /> TOTAL DUE this Billing Period S 332.50 <br /> PAYMENT <br /> RECEIVED <br /> MAR 2 6 2003 114k U0 011 <br /> SAN JOAQUIN COUNdy <br /> PUBLIC EW RONMENTALLHHEATH I I ISIA <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 all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10 <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5255.rpt <br />