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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTV—"'T <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Pho-: (209) 468-3420 <br />INVOICE <br />BRYAN, MATTHEW <br />WALMART #1789 <br />702 SW 8TH ST <br />BENTONVILLE, AR 72716-0555 <br />Lx <br />Page 1 <br />Account ID <br />AR0009063 <br />Facility ID <br />FA0006691 <br />Date Printed <br />2/5/2004 <br />RE: WALMART #1789 <br />2350 W KETTI_EMAN LN <br />LODI, CA 95242 <br />OWNER : WALMART, INC " <br />Date Health <br />Program Description Amount <br />Invoice # IN0116216 — Date of Invoice : 2/4/2004 <br />2/4/2004 2220 SM HW GEN <5 TONSNR <br />2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br />$ <br />200.00 <br />$ <br />24.00 <br />Total for this Invoice $ <br />224.Q0 <br />Payment Due Date <br />316/2004 <br />TOTAL DUE this Billing Period $ /"- 224.00] <br />PAYMENT <br />CRECEIVED . <br />1 .r r <br />FES 6 ?n,4 <br />SARIJOAOUIN cn, "'I'i I <br />I FJd1]'{Fi6WENTAL <br />IJEALTH UEPARTMEi T <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 OES I HIVIMP 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 thereafte <br />255 -rpt <br />