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ENVIRONMENTAL HEALTH DEPARTMENT a0e 1 <br /> 500 E MAIN STREET <br /> STOCKTON, CA 95202 ` <br /> Phone: (209) 468-3420 COPY <br /> INVOICE 3 5 �l `� Account ID FAR0022807 <br /> Facility ID F FA0013650 <br /> Date Printed 3/31/2010 <br /> GILLS SMOG CHECK RE : GILLS SMOG CHECK <br /> 7777 S BATES RD 2171 E CHEROKEE <br /> TRACY, CA 95304 STOCKTON, CA 95205 <br /> OWNER : SINGH, BAGGA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0199184--Date of invoice: 2/2/2010 1 MIT 11111111111111111111111111111111111111111111111111111111111111111111111111111 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <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 $ 8.50 <br /> Total for this Invoice $ 142.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> lZ6J �iRif{-P�� <br /> Z' <br /> Dehr,g11-e I6 c ,,arges <br /> pp 77 <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 />