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ENVIRONMENTAL HEALTH DEPARTME"T Pane 1 <br /> 600 E MAIN STREET / <br /> PTO CA 95202 COPY <br /> Phone:e: (209(209) 468-3420 ' � I d <br /> INVOICE Account ID r AR0035510 <br /> Facility ID F FA00 99931 <br /> LUMMMONMWMRWO <br /> Date Printed F 3131/2010 <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# IN0200920---Date of Invoice: 2/2/2010 11111111 HIT 111111111111111111111111111111111111111111111111 IIH ATIIIII 11111111 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this Involcel $ 142.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> 3U U . <br /> Delinquent oharrgeF <br /> will be forwarded to <br /> ir- !30 da'vs. <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/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 />