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SAN JUAti UIN GUUN I Y <br /> ENVI,;�ONMENTAL HEALTH DEPARTMT • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0020415 <br /> Facility ID FA0012503 <br /> Date Printed 1/30/2006 <br /> SAN JOAQUIN RIVER CLUB RE : SAN JOAQUIN RIVER CLUB <br /> 30000 KASSON RD 30000 KASSON RD <br /> TRACY, CA 95376 TRACY, CA 95376 <br /> OWNER : SAN JOAQUIN RIVER CLUB <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143196--Date of Invoice: 1127/2006 11111111 IIIIII IIIIIIII IIIII IIIIIIIIII IIIII IIIII IIIIIIIIII IIIII IIII IIIIII IIIII IIII IIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date __-311/2006 <br /> TOTAL DUE this Billing Perio $ 224/00 <br /> PAYENT <br /> RECEIVED <br /> FEB 0 9 2006 <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 /> Penalties will be added to all Permit Fees For DES I 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 />