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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART ST Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> <br /> ccount ID AR0010443 <br /> Facility ID FA0007174 <br /> Date Printed 1/24/2005 <br /> SAN-I-PAK INC RE : SAN-I-PAK INC <br /> PO BOX 1183 23535 S BIRD RD <br /> TRACY, CA 95378-1183 TRACY, CA 95376 <br /> OWNER : SAN-I-PAK INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128207--Date of Invoice : 1/24/2005 I IIIIIII IIIII III VIII VIII VIII VIII VIII VIII IIIII IIIII VIII IIIIIIIIII VIII lA IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 345.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE S 24.00 <br /> Total for this Invoicel $ 569.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 569.00 <br /> PAYMENT <br /> RECEIVED REI✓EIVED <br /> rER " ? r FEB 2 5 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> rpt. <br /> FNTC�i\ n <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.r-pt <br />