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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP RTMr 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOO <br /> STOCKTON, Cd 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0016148 <br /> Facility ID FA0009148 <br /> Date Printed 2/5/2004 <br /> GURTEJSINGH RAR RE PARK AVE CLEANERS <br /> PARK AVE CLE. <br /> ERS 1296 W 11TH ST <br /> 2529 TRACY BLVO TRACY, CA 95376 <br /> TRACY, CA 9537 <br /> OWNER : BRAR, GURTEJ SINGH <br /> Date Health <br /> Program Descripti Amount <br /> Invoice# IN0115546---Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW N<5 TONSNR $ 200.00 <br /> 2/4/2004 2399 UNIFIED ROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 224.00 <br /> T A 7" <br /> Lon Se� <br /> S <br /> Loci+ 9W ,,.o z o u.s e a r 1 <br /> 121 ck uP a y, D ie <br /> SPS c✓in� a n� (� y wt G>d <br /> 3 70 <br /> C,fl/ off (,2-a e> <br /> FEB 13 2004 <br /> ENVIRONMENT HEALTH <br /> PERMIT/WyjgFr�ake Checks PA ABLE 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.rpt <br />