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ENVIRONMENTAL HEALTH DEPARTME"tT <br /> 600 E MAIN STREET Pagt <br /> STOCKTON, CA 95202 ./ <br /> Phone: (209) 468-3420 <br /> INVOICE Q t Account ID AR0017429 <br /> Facility ID FA0010429 <br /> Date Printed 4/28/2010 <br /> DOUBLE A TRUCK SVC <br /> PO BOX 1402 RE : DOUBLE A TRUCK SVC <br /> DISCOVERY BAY, CA 94505-7402 1675 W CHARTER WAY D <br /> STOCKTON, CA 95206 <br /> OWNER : ANDREW SALMERON SR <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0198086­Date ofinvoice: 2/2/2010 1111111111 IN 1111111111111111111 <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 285.00 <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 $ 28.50 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 788.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 788.50 <br /> L � of <br /> Delinquent Charges <br /> will be fie:�Valyd,:9d t©s. <br /> COL.'f�E;C", n@„a, cam'! <br /> ac 30 datr^ <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 I 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 />