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SAN .1UAUUIN GUUNI Y <br /> ENVIRONMENTAL HEALTH DEPART MT • Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 II // COPY <br /> INVOICE LP Account ID RR0017758 <br /> Facility ID I FA001075588 <br /> Date Printed 4/28/2011 <br /> AD FORCE PRIVATE SECURITY RE : AD FORCE PRIVATE SECURITY <br /> PO BOX 55331 3108 CHERRYLAND AVE <br /> STOCKTON, CA 95205 STOCKTON, CA 95215 <br /> OWNER : GEORGE GARCIA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0211894--Date of Invoice: 1/31/2011 IIIIIIII111111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII111111111111111INIIII <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 /> [PAISSTF <br /> LOUE <br /> Delinquent changes <br /> will he forwarded to <br /> CGY'-,LEILC T 0O ON 0 <br /> in 30 days. <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 />