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Page 1 <br /> SAN JOAOUIN COUNTY PUBLIC I;,.(LTH SERVICES —i <br /> ENVIRONMENTAL HEALTH DMSION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0016876 <br /> FA0009876 <br /> Facility ID <br /> Date Printed <br /> 1131/01 <br /> BLAINS J DEJONG <br /> RE : BLAINE DEJONG'S AUTO WORKS INC <br /> 324 N CLUFF AVE <br /> BLAINE DEJONG'S AUTO WORKS INC LODI CA 95240 20 . <br /> 324 N CLUFF AVE <br /> LODI CA 95240 OWNER: BLAINE DEJONG'S AUTO WORKS INC <br /> Health Hrs Employee Amount <br /> Uate Program Description - <br /> Invoice# IN0080205--Date of Invoice: 1130101 <br /> $100.00 <br /> 1130/2001 2220 SM HW GEN<5 TONS/YR $10.00 <br /> 113012001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE Total for this Invoice $110.00 <br /> Payment Due Date 31212001 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees <br /> 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 thereafter <br /> 5255.rpt <br />