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SAN JOAQUIN COUNTY • Page 1 <br /> ENVIRONMENTAL HEALTH DEPART 0T <br /> 304 E WEBER AVE-3RD.FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0029741 <br /> LOMMMMMMMMMA <br /> Cf 1p . FacilityID FA0016351 <br /> t✓ Date Printed 7/29/2005 <br /> LMOMMOMMONEMME <br /> MELVIN ROUSH RE : VALLEY VINEYARD & ORCHARD SUPPLY <br /> VALLEY VINEYARD & ORCHARD SUPPLY 420 N SACRAMENTO ST <br /> <br /> <br /> OWNER : ROUSH, MELVIN D <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0135886—Date of Invoice: 712912005 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIVIIIVIII VIIIIIIIIIIIIVIII IIIIIII <br /> 7/29/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 7/29/2005 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this invoice § 224.00 <br /> Payment Due Date 8/2812005 <br /> TOTAL DUE this Billing Period $ 224.00 <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/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 />