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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF-'T <br /> 304 E WEBER AVE -3RD FLOOR �- <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0017623 <br /> Facility ID F FA0010623 <br /> LMMMMMMMWMNEIN <br /> Date Printed 1/30/2006 <br /> LONNOMMMMENOMM <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 /> Date Health <br /> Proaram Description Amount <br /> Invoice# IN0143077---Date of Invoice : 1127/2006 IIIIIiII VIIIIIIIIIVIIIIVIIIVIIIVIIIIIIIIIIIIIIIIVIIIIIIIIII <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 255.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 479.00 <br /> Payment Due Date 3/112006 <br /> TOTAL DUE this Billing Period $ 479.00 <br /> F'aYl47E1,1'r <br /> !41.gp - 1 20i ') <br /> SAN JOAOUTAi ppNNT'.� <br /> ENVIRONpfEN <br /> HEALTH OFwpprTL <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/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 />