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bAN.1UAUUIN ILUUN1Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page t <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY Phone: (209) 468-3420 <br /> INVOICE Account ID AR0028865 <br /> OFacility ID I FA0016404 <br /> \� Date Printed F 4/28/2011 <br /> A&D RUBBER PRODUCTS CO INC RE : A&D RUBBER PRODUCTS CO INC <br /> 1438 BOURBON <br /> 95204 <br /> OWNER : A&D RUBBER PRODUCTS CO INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0212502---Date of Invoice: 1/31/2011 IIIIIIIIIIIIVIIVIIITIIIIIIIIIIDIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 330.00 <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 $ 33.00 <br /> Total for thisInvoice $ 412.00 <br /> Payment Due Date 31212011 <br /> TOTAL DUE this Billing Period $ 412.00 <br /> U <br /> Delinquent charges <br /> will bep forwarded to <br /> 2y <br /> f ... 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/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 />