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5ANdUAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME— <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 1 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID r AR0028865 <br /> Facility ID FA0016404 <br /> Date Printed 3/31/2010 <br /> A&D RUBBER PRODUCTS CO INC RE : A&D RUBBER PRODUCTS CO INC <br /> 1438 <br /> , CA 95204 <br /> OWNER : A&D RUBBER PRODUCTS CO INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0199532--Date of Invoice: 2/2/2010 lllll IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII Illi Ill/IIIIII 1111111111111 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 360.00 <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 $ 36.00 <br /> Total forthis Invoicel $ 445.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 445.00 <br /> Daunt l Rena; char ges <br /> will <br /> h? 1, "fare€dedgZo <br /> in 30 dz;4B- .. «r <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 />