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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMPage , <br /> � <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD nRoo,7asa <br /> Facility ID FA 0010488 <br /> LANNUMEMMMMUMMA <br /> Date Printed 1/28/2008 <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# IN0170533---Date of Invoice: 1/25/2008 IIIIIIIIIIVIIIVIIIVIVII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIII <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 130.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 367.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $ 367.0 <br /> PAYMENT <br /> RECEI\iFn <br /> FEB 5 zOub <br /> 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/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 />