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ENVIRONMENTAL HEALTH DEPARTMENT yy <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 -+ <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0016333 <br /> 3 ) 7 `T <br /> Facility ID FA0009333 <br /> Date Printed 5/27/2009 <br /> C DEJONG TRUCKING INC RE : C DEJONG TRUCKING INC <br /> PO BOX 126 24975 S AUSTIN RD <br /> RIPON, CA 95366 RIPON, CA 95366 <br /> OWNER : C DEJONG TRUCKING INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184062--Date of Invoice : 1/29/2009 11111111111111111 ME 11111111111111 1111111111111111111 <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 300.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 30.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 780.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 780.00 <br /> AA , Lj 6E-- <br /> Delinquent <br /> Delinquent charges <br /> will he forwarded to <br /> COLLECTIONS <br /> in 130 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 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 /> 5254.rpt <br />