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'IML HILALTH DEPARTMF"IT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95201 Page I <br /> Phone: (209)468-3420 ..i <br /> INVOICE ACcountlD AR0018067 <br /> Facility ID FA0011067 <br /> Date Printed 4!28/2010 <br /> FARIAS AUTO REPAIR RE : FARIAS AUTO REPAIR <br /> 2029 <br /> , CA 95205 <br /> OWNER : FARIAS, JOSE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0196868---Date ofInvoice: 12/23/2009 IIIIIIIIIIIIIIIIVIIVIIVIVIIVIIIVIIVIII'llllllllllllllllll <br /> Hrs Employee <br /> 11/6/2009 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 CACAPIT $ 57.50 <br /> 3/15/2010 9988 SERVICE CHARGE PENALTY $ 5.75 <br /> 4/15/2010 9988 SERVICE CHARGE PENALTY $ 5.75 <br /> Total for this Invoice $ 69.00 <br /> PAST DUE <br /> Invoice# IN0198502--Date of Invoice: 2/2/2010 1111111 IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII/ill <br /> 211/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 100.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/2012010 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this invoice $ 585.00 <br /> Payment Due Date 3/4/2010 <br /> lk. TOTAL DUE this Billing Period $ 654.00 <br /> Delinquent ChergP_S' <br /> will be "€0mvar'vd 10 <br /> in WO da . <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 />