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EAVIRONMENTAL HEALTH DEPARTME"T rays i <br /> 600-E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE6�j b R0 <br /> Account ID A037485 <br /> niit b <br /> Facility ID FA0020866 <br /> SAi 10ACUIN3 COUNTY <br /> 1���I�i� �Ei��RGE4�CY Si�VICF bate Printed 8/24/2011 <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 /> Invoice# IN0217273—Date of Invoice: 5/25/2011 11111111 Illlii III IIIII Illll 11111 llllf illi illll i[ill 11111 11111 11111 Illi illlll llfll 1111 1111 <br /> 5/25/2011 2244 2011 HAZMAT FEE PLUS 4 YEARS BACK BILLING $ 1,875.00 <br /> 5/25/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 5/25/2011 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 7/15/2011 9987 Haz Mat Program Penalty Fee $ 187.50 <br /> Total forthls Invoice $ 2,111.50 I <br /> Payment Due Date 6/2512011 <br /> TOTAL DUE this Billing Period $ 2,111.50 <br /> I <br /> CpAS f� <br /> Velinquelit c hatgc's <br /> will be forwarded to <br /> COLLECTIONS <br /> in 30. days- 1 <br /> I <br /> i <br /> 1 <br /> i <br /> i <br /> I <br /> Please make Checks PAYABLE to: 'EHD' Return a Copy of This STATEMENT with Your PAYMENT i <br /> Penalties will be added to all Permit Fees For OES 1 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 wilt 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 `I <br /> 5254.mt II <br /> i <br />