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Pace 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 - COPY <br /> Phone: (209) 468-3420 <br /> INVOICE ' 1 _ 1 1 Account ID AR0034306 <br /> �(J Facility ID FA0 0-19-2 9-2 <br /> Date Printed F-3/31/201-6 <br /> FERMIN ALUSTIZA RE : FERMIN ALUSTIZA <br /> 8250 SEGARINI CT 820 CHANNEL ST <br /> STOCKTON, CA 95209 STOCKTON, CA 95202 <br /> OWNER : FERMIN ALUSTIZA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0200750---Date of Invoice: 212/2010 111111111111111111111111 IN <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 270.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice $ 346.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 346.00 <br /> I <br /> UUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECTIC;N5S <br /> in 30 Mays. <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 /> i254-rpt <br />