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JFi1V avria.turry ..vvry r r Page 1 ENVIRONMENTAL HEALTH DEPARTS 1868 E HAZELTON AVENUE STOCKTON, CA 95205 'NVQ'C Col 1 Account lD AR0016961 Y Y � 11fn�V Facility ID FMWOMMMEMM A0009961 Date Printed 5/30/2012 CALIFORNIA STATE BLDG RE : CALIFORNIA STATE BLDG 31 E CHANNEL ST#108 31 E CHANNEL ST 108 STOCKTON, CA 95202 STOCKTON, CA 95202 OWNER : CALIFORNIA STATE BLDG Date Health Program Description Amount Invoice# IN0220753---Date of Invoice: 11/28/2011 1111111 HIT 111111111111111111111111111111111111111111111111111111111111111 Hrs Employee 10/12/2011 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 WONG $ 62.50 2/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 3/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 4/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 Total for[his Invoice $ 81.25 PAST DUE Invoice# IN0223453---Date ofInvoice: 113012012 IIIIIIIilllllllVIIIIIIIIIIIIIIIVIIIVIIVIIVIIIVIIIIIIIIIIVIIIIIIIIII 1/27/2012 2220 SM HW GEN<5 TONSNR $ 213.00 1/27/2012 2244 2012 HAZMAT FEE $ 85.00 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 1/2712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 3/15/2012 9987 Haz Mat Program Penalty Fee $ 8.50 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 Total for this Invoice $ 568.50 PAST DUE TOTAL DUE this Billing Period $ 649.75 PAST D U E Delinquent charges will be forwarded to C®LLEC'1i'I]ONS in 30 days. Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For OES/HMMP Fees For all SERVICE FEES at Rate of 1,QQ[o.ofthe Base Fee Penalties will be added at the Rate of 10% Penalties will be added atthe Rate of 10% -. .- 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter