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Z* JVHVUIN L'UUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF^l T <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE 1 Account ID AR0017470 <br /> l Facility ID FA001 4470 <br /> Lanumummmmmmom <br /> -------------- <br /> Date Printed 4/28/2010 <br /> lommmmmmmoomma <br /> ELEGANT SURFACES RE : ELEGANT SURFACES <br /> 551 CARNEGIE ST 551 CARNEGIE ST <br /> MANTECA, CA 95337 MANTECA, CA 95337 <br /> OWNER : POLIMENO, JOHN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0198091 ---Date of Invoice : 2/2/2010 11111111111111 1111111111 HEIN11111111111INIIII <br /> 2/1/2010 2220 SM HW GEN <5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 315.00 <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 $ 31.50 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 821.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 821.50 <br /> Deline,UG;jf Charrjes <br /> Will ire fcs"1n ardi,r� f F <br /> a <br /> . , Ir 30 <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 />