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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM- 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> ount ID RR 00 66474 <br /> Facility ID FA0009474 <br /> Date Panted 3/17/2003 <br /> LODI WATER DIV(WELL#16) PRIM 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# IN0104064---Date of Invoice: 2/27/2003 <br /> 2/27/2003 2214 CaIARP FAC STATE SURCHARGE FEE $ 200.00 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 / <br /> 2/27/2003 2244 2003 HAZMAT FEE $ 315.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total forthis Invoice $ 732.50 <br /> Payment Due Date 3129/2003 <br /> TOTAL DUE this Billing Period $ 32.50 <br /> RECE 1/ED <br /> R <br /> ?003 <br /> ENVIPUSAN <br /> B C/EQL/NCOUNTY <br /> RONMENTgt HEA/TH nCES ON <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 />