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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 /> Account ID AR0016474 <br /> Facility ID F FA0009474 <br /> Date Pnnted F 2/5/2004 <br /> WHITE SLOUGH WATER POLLUTION CNTRL RE : WHITE SLOUGH WATER POLLUTION CNTRL <br /> 1331 S HAM LN 12751 N THORNTON RD <br /> LODI, CA 95242 LODI, CA 95242 <br /> OWNER : CITY OF LODI <br /> Date Health <br /> Program Description .Amount <br /> Invoice M IN01_16_ 2_40,--Date of Invoice( 2/4/2004 <br /> 2/4/2004 2214 CalARP FAC STATE SURCHARGE FEE $ 270.00 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 315.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total tar this Invoice $ 809.00 <br /> Payment Due Date 3/ 004 <br /> TOTAL DUE this Billing Period $ 809.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR 1 - 2004 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> RECEIVED <br /> FcB 1 5 2ruQ4 <br /> ACCOUNTINF" <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 />