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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMff Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0017067 <br /> Facility ID FA0010067 <br /> Date Printed 1/28/2008 <br /> BROADBASE INC dba JIFFY LUBE RE : JIFFY LUBE#2497 <br /> JIFFY LUBE #2497 4715 N WEST LN <br /> 1471 SHORE ST STOCKTON, CA 95210 <br /> WEST SACRAMENTO, CA 95691 <br /> OWNER : FOWLER, DON W <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0170401 ---Date of Invoice: 1/25/2008 IIIIIIIIII VIIIIIIIIIIIVIIVI VIVIIVIIVIIIIIIII IIIIIIIII IIII <br /> 1/25/2008 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 330.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forth is Invoicel $ 567.00 <br /> Payment Due Date 2/27/2008 <br /> TOTAL DUE this Billing Period $ 567.00 <br /> REC VED <br /> FEB i 2 2008 <br /> Sf Je J�ROt" TME <br /> HF jN1) <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 />