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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016961 <br /> Facility ID F FA0009961 <br /> LNWNMWNNWWMWWM <br /> Date Printed 3/28/2012 <br /> CALIFORNIA STATE BLDG RE : CALIFORNIA STATE BLDG <br /> 31 E CHANNEL ST#108 31 E CHANNEL ST 108 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 <br /> OWNER : CALIFORNIA STATE BLDG <br /> Date Health <br /> Program Description Amount <br /> Invoice# ING220753---Date of Invoice: 11/2812011 IIIIIIII II VI I I I I V III V IIV VII / I I V /I /III <br /> Hrs Employee <br /> 10/12/2011 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 WONG $ 62.50 <br /> 2115/2012 9988 SERVICE CHARGE PENALTY $ 6.25 <br /> 3/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 <br /> Total for this Invoice $ 75.00 <br /> PAST DUE <br /> Invoice# IN0223453---Date of Invoice: 1/3012012IIIIII/IIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII/IIIIIIII/III <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 85.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1127/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this Invoice $ 355.50 <br /> Payment Due Date 2129/2012 <br /> TOTAL DUE this Billing Period $ 430.50 <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 />