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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPA TP" 'IT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR _ <br /> STOCKTON, <br /> <br /> Account ID AR00 961 97 <br /> Facility ID FA0009997 III <br /> Date Printed 1/24/2005 <br /> COUNTRY CLUB SERVICE RE : COUNTRY CLUB SERVICE <br /> 1403 W COUNTRYI CLUB BLVD 1403 W COUNTRY CLUB BLVD <br /> STOCKTON, CA 915204 STOCKTON, CA 95204 <br /> OWNER : GRIFFEN, STEPHEN <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0128164---Date of Invoice: 1/24/2005 11111111111111111111INIIIININIINIIINIIIIIIII IN <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZ AT FEE $ 145.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 369.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 369.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 9 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 /> >2>?.rpt <br />