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JHIV ./UHUUIN I.VUNI T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMFNT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 COPY <br /> iy <br /> INVOICE <br /> Account ID ARoo35510 <br /> Facility ID FA0019931 <br /> Date Printed F 4/28/2011 <br /> LEMMOMENOMMOMO <br /> FERGUSON WATERWORKS RE : FERGUSON WATERWORKS <br /> 1102 S AURORA ST 1102 S AURORA ST <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER : FERGUSON ENT <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0213825---Date of Invoice: 1/3112 01 1 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIVIIIVIIIIIIIIIIIVIIIIIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 85.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> I —Tota l for this Invoice $ 142.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> -s' <br /> Delinquent chargee <br /> will be orw rded to <br /> in 30 days. <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 DES I 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 /> 5254 rpt <br />