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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP RTV'NT Page 1 <br /> 600 E MAIN STREET <br /> ST <br /> (209) 468-3420 <br /> INVOICE AccountlD AR0016310 <br /> Facility ID FA0009310 <br /> Date Printed 1/29� <br /> DSW AG INC RE : DSW AG INC <br /> PO BOX 311 15910 N DAVIS RD <br /> LODI, CA 95241-1'311 LODI, CA 95242 <br /> OWNER : D & C WORTLEY 1995 FAMILY TRUS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184943---Date of Invoice: 1/29/2009 1IN$E111 III IIIII IIIII IIIII 11111 11111 11111 11111 11111 11111 1111 111111 11111 1111 1111 <br /> 1/29/2009 2220 SM HW CEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 375.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 612.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 2.00 <br /> RECEIVE0� <br /> FEB 1 1 2009 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks P�YABLE 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 /> i254.rpt <br />