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JAN JUAUUIN k UUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMr IT <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKT <br /> <br /> INVOICE Account ID AR0006259 <br /> Facility ID FA0005626 <br /> Date Printed 1/30/2006A <br /> SANBORN CHEVROLET INC RE : SANBORN CHEVROLET INC <br /> PO BOX 1057 1210 S CHEROKEE LN <br /> LODI, CA 95241-1057 LODI, CA 95241 <br /> OWNER : SANBORN CHEVROLET INC <br /> Date Health <br /> Program Descriptio i Amount <br /> Invoice# IN0142485---Date of Invoice: 1/27/2006 11111 11111 11111 11111 11$11111 11111 11111 11111 1111 111111 11111 IN IN <br /> 1/27/2006 2227 GEN 5<21TONS PERMIT $ 1,568.00 <br /> 1/27/2006 2244 2006 H"AT FEE $ 405.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 1,997.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $/ 1,997. <br /> PAYMENT <br /> REC!E-1VF-D <br /> F� , 2 7 2006 <br /> SAN JOACUW COL-14TY <br /> ENWFIQ!MENTAL 7 <br /> HEALTH 4)EPARTMENr <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 IDES/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 />