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SAN JOAQUIN COUNTY Page 1 <br /> EZ11RONMENTAL HEALTH DEPARTME <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95 <br /> <br /> nt ID AR0003380 <br /> Facility ID FA0003795 <br /> Date Printed 2/5/2004 <br /> LIBERTY RURAL FIRE DISTRICT RE : LIBERTY RURAL FIRE DISTRICT <br /> 24124 N BRUELLA RD 24124 N BRUELLA RD <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 <br /> OWNER : LIBERTY RURAL FIRE DISTRICT <br /> Health ealthProgram Descripti6 Amount <br /> Invoice# IN0115677---Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoicel $ 224.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 224.00 <br /> PA` t\AF-NT <br /> RECEIVES <br /> VES 2 S ?('r" <br /> SAN JOAQI_IIN COUN" <br /> ENVII?r)NIVIE <br /> HEALTH DEPAFITtrijcNT <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 /> 5255.rpt <br />