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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTNW - , ., • <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 AMENDED <br /> INVOICE AccountlD AR0028468 <br /> Facility ID FA0016278 <br /> Date Printed 5/29/2007 <br /> BROADBASE INC dba JIFFY LUBE RE : JIFFY LUBE#1478 <br /> JIFFY LUBE#1478 1648 E HAMMER LN <br /> 730 S BECKMAN RD STE B STOCKTON, CA 95210 <br /> LODI, CA 95240 OWNER : FOWLER, DON W <br /> Health Amount <br /> Date program Description — <br /> Invoice# IN0158504--Date of Invoice: 112512007 IIIIIIIIIIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIIIIIIII IIII IIII <br /> $ 206.00 <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 330.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 24.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE ($ 560.00) <br /> 2/23/2007 9999 PAYMENT ($ 206.00) <br /> 5/15/2007 9997 CORRECTION TO A CHARGE $ 2,076.00 <br /> 5/29/2007 2229 GEN 50<250 TONS PERMIT <br /> Total for this Invoice $ 1,870.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period <br /> ti��' <br /> JUN 12 2007 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penalties will be added to all Permit Fees For be a I ed at Fees Penalties will be added at the Rate of 10% <br /> at the Rate of 100°/of the Base Fee Penalties will be added at the Rate of 10% 60 Days after the Invoice Date and each 30 Days thereafter <br /> 30 Days after the Due Date 45 Days after the Invoice Date Y <br /> 5254.Tt <br />