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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON <br /> <br /> ccountlD AR0016386 <br /> Facility ID FA0009386 <br /> Date Printed 3/10/2005 <br /> FIELD TOWER SYSTEMS (KS SOLUTI RE : FIELD TOWER SYSTEMS (KS SOLUTIONS) <br /> PO BOX 504 28135 E COPPEROPOLIS RD <br /> ELVERTA, CA 95626 FARMINGTON, CA 95230 <br /> OWNER : FIELD, DAVID <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0129998---Date of Invoice: 1/24/2005 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII 11111111111 IIII IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 85.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 309.00 <br /> Payment Due Date2/23/2 <br /> TOTAL DUE this Billing Period $ 309.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR - 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 Feels 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 />