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cINVIKUNMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE -3RD FLOOR Page 1 <br /> STOGKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE <br /> Account ID AR0022667 <br /> ,IAN 2 S RECD Facility ID FA0013558 <br /> Date Printed 1/24/2005 <br /> <br /> <br /> LODI, CA 95240 <br /> OWNER : KEMPER REFRIGERATION <br /> Data Health <br /> Program Description <br /> Amount <br /> Invoice# IN0128539—Date of Invoice: 1/24/2005 IIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHill INIIIIIIIII IIIIIIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 200.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 285.00 <br /> $ 24.00 <br /> Total for this Invoice $ 509.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period <br /> $ 509.00 <br /> FEB <br /> �2yoR`� <br /> PAYMENT <br /> RECEIVED <br /> FEB 9 2005 <br /> SAN JOAOUIN 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 /> 5255.rpt <br />