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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART11i .,MW Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR003508fi <br /> Facility ID FA0019724 <br /> Date Printed 5f2612015 <br /> INDEPENDENT LIFT TRUCK RE : INDEPENDENT LIFT TRUCK <br /> PO BOX 723 824 S CENTER ST <br /> STOCKTON, CA 95201 STOCKTON, CA 95206 <br /> OWNER : KURT PURSLEY <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0263072---Date of Invoice: 1129/2015 11111111Ell III IIIII111!11111111111Ifli111111111111!11111l111[11111$ INN <br /> 1129/2015 1920 HMBP-Common Materials S 85.00 <br /> 1/2912015 2220 SM i GEN<5 TONS/YR $ 213.00 <br /> 112912015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> 3/15/2015 9987 Haz Mat Program Penalty Fee S 8.50 <br /> 4/1512015 9994 PERMIT FEE PENALTY S 213.00 <br /> Total for this Invoice $ 554.50 <br /> PAST DUE <br /> PAST DUE TOTAL DUE this Billing Period $ 554.50 <br /> Delinquent charges <br /> will be forwarded to <br /> C;0 LLECTION S <br /> in 30 days. <br /> Please make Checks PAYABLE to: 'El — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base t=ee 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 />