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SAN JOAQUIN COUNTY 0� <br />ENVIRONMENTAL HEALTH DEPARTME-"Y <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />LICENSING <br />WALMART #1789 <br />702 SW EIGHTH ST <br />BENTONVILLE, AR 72716-0500 <br />Date Health <br />Program Description <br />41 Page 1 <br />Account ID <br />AR0009063 <br />Facility ID <br />FA0006691 <br />Date Printed <br />1/26/2007 <br />RE: WALMART #1789 <br />2350 W KETTLEMAN LN <br />LODI, CA 95242 <br />OWNER: WALMART, INC <br />Invoice # IN0157059 --- Date of Invoice : 112512007 <br />1/25/2007 2220 SM HW GEN <5 TONSNR <br />1/25/2007 2244 2007 HAZMAT FEE <br />1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />Amount <br />11111111 1 1 1 1 1 Ill I I I I I I I I I I I III I I!I II I I I I I Ili I! II II1 1 1 1 1 1 II II I I I I 1111111 <br />$ <br />I I I I I II II I I I <br />206.00 <br />$ <br />285.00 <br />$ <br />24.00 <br />Total for this Invoice $ 615.00 <br />Payment Due Date 2/25/2007 <br />TOTAL DUE this Billing Period $ 515.0 <br />t 9 <br />PAYMENT <br />RECEIVED <br />F�.g � a X007 <br />4-3oaQUti1'4 COUT4V <br />NV1ROl1MMM <br />�GMTH DE13 <br />Please make Checks PAYABLE to: 'EHD' _ Return a Copy of This STATEMENT with Your PAYMENT <br />'enalties will be added to all Permit Fees For OES 1 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 Irivoice Date 60 Days after the Invoice Date and each 30 Days thereafte <br />5254.rpt <br />