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SAN JOAQUINCOUNTY <br /> ENVIRONMENTAL HEALTH DEPAR NT Page <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 1 <br /> Phone: (209)468-3420 <br /> Received <br /> INVOICE Account 10 AR0004064 <br /> JAN 2 8 1005 <br /> Fatality ID F FA0004382 <br /> AnlerOfl - Tracy <br /> Date Printed F 1/24/2005 <br /> AMERON INTERNATIONAL RE : AMERON INTERNATIONAL <br /> 10100 <br /> CA 95377 <br /> OWNER : AMERON INTERNATIONAL <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0129032—Date of Invoice: 1/24/2005 1I111II1II1111I11I1IHE111I111II1III11I111II111HII IIII <br /> 1/24/2005 2227 GEN 5Q5 TONS PERMIT $ 1,568.00 <br /> 1/2412005 2244 2005 HAZMAT FEE $ 525.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice § 2,117.00 <br /> Payment Due Date 2/2312005 <br /> TOTAL DUE this Billing Period 4 2,117.00 <br /> COPY <br /> JAN 2 8 2005 PAYMENT. <br /> TO <br /> RECEIVED <br /> (Q FEB 1 8 2005 <br /> p �• 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 /> 525Srpt <br />