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SAN JOAQUIN COUNTY <br /> E ENVIRONMENTAL HEALTH DEPARTMWT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 ' <br /> Phone: (209)468-3420 <br /> INVOICE Accou nt iD AR0037485 <br /> FacilityID FA0020866 <br /> Date Printed 3/28/2012 <br /> DEBRUIN CONSTRUCTION INC RE : DEBRUIN CONSTRUCTION INC <br /> PO BOX 1355 1045 W CHARTER WAY <br /> FRENCH CAMP, CA 95231 STOCKTON, CA 95206.. <br /> OWNER : RICHARD DEBRUIN <br /> Date Health <br /> Program Description Amount <br /> II . <br /> Invoice# IN0226474---Date of Invoice: 1130!2012 Il1111IlIIIIIIII[IlfiIIII�IIIIIIIIIII IiIIIII�IIIIIIIIIIIIIIII1III IIIII Ilflllllllll <br /> 1/27/2012 2244 2012 HAZMAT FEE. $ 375.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz.Mat Program Penalty Fee $ 37.50 <br /> Total forthis Invoice $ 461.50 <br /> Payment Duo Date 2/29/2012 <br /> TOTAL DUE this Billing Periodl 461.50 <br /> II <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%9 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 />