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SAN,:OAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART VT <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0017623 <br /> LMOMMONOMMMOMMM <br /> Facility ID FA0010623 <br /> Date Punted 1/24/2005 <br /> LUMEMEMMEMMWNA <br /> SAM LUNG LAUNDRY INC RE : SAM LUNG LAUNDRY INC <br /> 742 E MAIN ST 742 E MAIN ST <br /> STOCKTON, CA 95202-3131 STOCKTON, CA 95202-3120 <br /> OWNER : TOY, SAM <br /> Health <br /> Date Program Drscriotion Amount <br /> Invoice# IN0128356—Date of Invoice : 1/24/2005 11p11p11IN1111111p11p111p1 <br /> 1/24/2005 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/24!2005 2244 2005 HAZMAT FEE $ 255.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 479.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $ 479.00PAYMI <br /> T <br /> RECEIVED <br /> FEB 2 3 2005 <br /> SAN JORONIME 0 ANT' <br /> HFALfH 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 /> 5255.rpt <br />