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SAN JOAQUIN COUNTY _ r' <br /> ENVIRONMENTAL HEALTH DEPARTMENT - <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209) 4683420 <br /> INVOICE i Account to ARoolsl,s <br /> �� <br /> Facility ID FA0009115 <br /> Date Printed 4/28/2011 <br /> PRODUCTION CAR CARE PROD (WHSE RE : PRODUCTION CAR CARE PROD <br /> 1000 E CHANNEL ST 1015 E CHANNEL ST <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : BOLER, LEWYN <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0211568--Date of Invoice: 113112011 11111111 111111 III VIII(IIII VIII IIIIIIIIII IIIIIIIIII VIII VIII IIII 111111 VIII IIII IIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 690.00 <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 $ 69.00 <br /> Total forthis Invoice $ 808.00 <br /> Payment Due Date 31212011 <br /> TOTAL DUE this Billing Period $ 808.00 <br /> Delinquent charges <br /> will be tont rded t0 <br /> Irk �® days.V.�1€'.N oma <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 1 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 />