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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 AccountlD ARaolsssl <br /> FacilitylD FA0009961 <br /> Date Printed 2/29/2012 <br /> INNOWNWOMMMOMMA <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# IN0220753---Date of Invoice: 11/28/2011 IIIIIIIIIIIIIIIIIIIVVIIVIIVIIVIIIII 111111111 IIII <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 /> Total far this Invoice $ 68.75 <br /> PAST DUE <br /> Invoice# IN0223453---Date of Invoice: 1/30/2012 IIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIilllllllllll IIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 85.00 <br /> 1127/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> Total for this Invoice $ 347.00 <br /> Payment Due Date 2/29/2012 <br /> TOTAL DUE this Billing Period $ 415.75 <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 OES/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 />