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ENVIRONMENTAL HEALTH DEPARTMFNT Page 1 <br /> 600 E MAIN STREET %woe <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE / t�� Account ID FAR0022807 <br /> LUEMEMOMMMMINA <br /> Facility ID FA0013650 <br /> Date Printed 4/28/2011 <br /> GILLS SMOG CHECK RE : GILLS SMOG CHECK <br /> 7777 S BATES RD 2171 E CHEROKEE <br /> TRACY, CA 95304-9154 STOCKTON, CA 95205 <br /> OWNER : SINGH, BAGGA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0212172---Date of Invoice: 1/31/2011 111111111111111111111111111111111111111111111111111111111111111 IN IIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 85.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this Invoice $ 142.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> I5Azi <br /> O, <br /> Delinquent charges <br /> will be forrsarded to <br /> C0I .LEC- B0','J 0 <br /> in 30 clays, <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/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 />