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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKPhone: ON,209 46 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0017488 <br /> LUMMEMEMMENNOWE <br /> Facility ID F FA0010488 <br /> 7-1 <br /> LWOMEMEMMMOMA <br /> Date Printed 1/30/2006 <br /> RICKY CHAM RE : ULTRACARE OF STOCKTON <br /> ULTRACARE OF STOCKTON 4629 N WEST LN STE 10 <br /> <br /> <br /> OWNER : CHAM, RICKY K <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143049—•Date of Invoice: 1/27/2006 IIIIIIIIIIIIIIVIIIVI VIIIVIIVIIIIIIIIIIIIIIIIIVIIIIIII IIIIIVIIIIIIIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 130.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forthis invoice $ 354.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 54.00 <br /> RCC ;ENT <br /> F-%gYMVs�D <br /> FEB 1 7 20pg <br /> IiEq VIRO M'-OUN7y <br /> N.A <br /> N OEP.gRT ENT <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 /> 5254.rpt <br />