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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM[ • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR00170 77 <br /> LMMMMMMOMMOM <br /> Facility ID I FA0010067 <br /> Date Printed 2/22/2006 <br /> BROADBASE INC dba JIFFY LUBE RE : JIFFY LUBE#2497 <br /> JIFFY LUBE#2497 4715 N WEST LN <br /> 730 S BECKMAN RD STE B STOCKTON, CA 95210 <br /> LODI, CA 95240 <br /> OWNER : FOWLER, DON W <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142911 --Date of Invoice: 1/27/2006 III III III111I IIII111I11111I1I I1II II1111I1 I11I VIII IN 1111111111111111111 <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 330.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 554.00 <br /> Payment Due Date 1/21)N <br /> TOTAL DUE this Billing Period <br /> P-'Ati`iL r <br /> SLC <br /> FEE 22 % . ; <br /> SAN,in <br /> HF=yO: , <br /> rr. <br /> ,an;T <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 /> 5254.rpt <br />