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SAN JOAQUIN COUNTY Page 1 <br /> EfAVIRf11NMENTAL HEALTH DEPARTRMT • <br /> 904 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0016644 <br /> Facility ID FA0009644 <br /> Date Printed F 2/27/2003 <br /> `z;0r <br /> COX BROS TIRE SERVICE RE : COX BROS TIRE SERVICE <br /> 507 E 11TH ST 507 E 11TH ST <br /> TRACY, CA 95376 TRACY, CA 95376 <br /> OWNER : EARL BREITSTEIN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0103546--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 $ 100.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this Invoice $ 317.50 <br /> Payment Due Date 3/29/2003 <br /> TOTAL DUE this Billing Period $ 17.50 <br /> PAYMENT <br /> RECEIVED <br /> MR 1 7 2003 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HE <br /> EWRONh1ENTALLTH H <br /> HEAL VICES DIVSION <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 />