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03/02/2010 16:30 209464013B ENVIROI, MAL HEALTH PAGE 01/01 <br /> SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTML, <br /> 600 E MAIN STREET_7� <br /> STOCKTON, CA 95202 <br /> Phone: (209)466-3420 RECEIVED <br /> R <br /> INVOICE a 1C6s MC AnD nROo+segs <br /> MAR —2 2010 Facility® F. FAOOOD576 mom <br /> SAN JOAQUIN COUNTY Data P j,t d F--2/2/-20 I-() <br /> IFFICE OF FMFRGENCY SERVICES <br /> DEJONG, BLAINE RE : BLAINE DEJONGS AUTO WORKS INC <br /> BLAINE DEJONG'S AUTO WORKS INC 324 N CLUFF AVE <br /> 324 N CLUFF AVE LOD4 CA 95240 <br /> LODI,CA 95240 OWNER: BLAINE DEJONG'S AUTO WORKS INC <br /> Health Amount <br /> Date Program Description <br /> Involde IN01979N—Daft of Invoice: 222010 ���R911N��iS I�I��mNnI g111�I�ISI�MA�"" <br /> S 213.00 <br /> 2/12010 2220 SM HW GEN<5 TONSlYR S 130.00 <br /> 2J12010 2244 2010 HAZMAT FEE S 24.00 <br /> 2/112010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 25.00 <br /> 2/12010 ERSC ELECTRONIC REPORTING SURCHARGE <br /> 7elai tothla in.otse $ 392.00 <br /> Payment Due Date 31412010 <br /> TOTAL DUE thh Bi6h1g Period S 392.00 <br /> Te) LN H O An I T A^ A Y GCW C. CIL ,j <br /> BLAIN; Oe Jor G$ At4ro wcgLkS /NC, /S v0 CONGER YK 436&S/NESS ANO HAS ^107' <br /> 6EEAl .*J 81As/r4 ESS S/.r C-c ��$/pq T//E /vE w T EN"Ar-Ir A 7- <br /> 33-2- <br /> _z q A. /V, Lcu F A1/E / S 7*0e Aa'ro wo/LAS f S�.OG._ THfl2 PHa�rC" # /S <br /> 2a9 - 33y- 6332_ . <br /> HEMMED <br /> FEB 2 6 nio <br /> ENVIRONMENT HEALTH <br /> PFRMIT/SEWCES <br /> Please make Cheeks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Yow PAYMENT <br /> For DES/HMNIP Fees For ail SERVICE FEES <br /> r <br /> enaltlas will be added m all Permit FM Penalties win"added at the Rate of 10% <br /> at the Rate of 100%of the D9aa Fee PenalDea will lx added at the Rale of 10Y. 60 Days atter the Involao Data end each 30 Days thereafta <br /> 30 Days*tier the Due Date 46 Days after,the invoice Date Y <br /> 5254.[% <br />