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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP.�RTM`T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0023280 <br /> Facility ID FA0013833 <br /> LMUMMMMUMEMa <br /> Date Printed 1 1/30/2006 <br /> BRYAN TEVES RE : WILSON & COFFEY APPLIANCES <br /> WILSON &COFFE APPLIANCES 2617 S EL DORADO ST <br /> 2617 S EL DORAD D ST STOCKTON, CA 95207 <br /> STOCKTON, CA 9 206 <br /> OWNER : PHILLIPS, LEON R <br /> Date Health <br /> Program Descriptio 1 Amount <br /> Invoice# IN0144393---Date of nvoice: /27/2006 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/27/2006 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 224.00 <br /> Payment Due Date 3/1/ <br /> TOTAL DUE this Billing Period $ 224.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 1 0 2U <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 /> i2i4.rpt <br />