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ENVIRONMENTAL HEALTH DEPARTME f <br /> 600 E MAIN STREET ' . <br /> STOCKTON,(209 46 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0026 887 <br /> Facility ID FA0015622 <br /> Date Printed 8/29/2008 <br /> GLORIA BALLESTEROS RE : DSJ CUSTOM CABINETS INC <br /> DSJ CUSTOM CABINETS INC 4843 E FREMONT <br /> 1844 E TENTH ST STOCKTON, CA 95215 <br /> STOCKTON, CA 95206 <br /> OWNER : PEREZ,DAVID/BALLESTEROS,GLORIA <br /> Health <br /> Date Program Description Amou^t <br /> Invoice# IN0179632•••Date of Invoice: 8/29/2008 IIIIIIIIIIIIII IIIIIIIIIIIIIIIIII VIIIIIIIIIIIII VIIIIIIIIIIIII IIII IIIIII VIII IIII IIII <br /> 8/29/2008 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 8/29/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for[his Invoice $ 237.00 <br /> Payment Due Date 9/2012e0@ <br /> TOTAL DUE this Billing Period $ 237 <br /> PAYMENT <br /> RECEIVED <br /> SEP 1 7 zoos <br /> SAA/JOA UIN CO0N7y <br /> ENViFIONMHEALTH DEPAq MENT <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 DES/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 />