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JAN JUAUU1N L;UUN I Y <br /> ENVIR014MENTAL HEALTH DEPARTMF Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0017097 <br /> Facility ID FA0010097 <br /> Date Printed 1/30/2006 <br /> STOCKTON AUTO DISMANTLERS INC RE : STOCKTON AUTO DISMANTLERS INC <br /> 3239 S EL DORADO ST 3239 S EL DORADO ST <br /> STOCKTON, CA 95206-3407 STOCKTON, CA 95206-3420 <br /> OWNER : DAVID W POTTS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142920---Date of Invoice: 1/27/2006 I IIIIIII IIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIIII IIIIIIIIII VIII IIII IIIIII VIII IIII IIII <br /> 1/27/2006 2220 SM HW GEN <5 TONSNR <br /> $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE <br /> $ 100.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 324.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 324.0 <br /> PAYMENT <br /> RECEIVED <br /> FEB U 9 <br /> SAN JOAQUIN COUN I Y <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> r" <br /> S <br /> L l <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 />