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SAN JOAQUIN COUNTY rdye i <br /> ENVIRONMENTAL HEALTH DEPARTMmNT <br /> •600 E MAIN STREET �- COPY <br /> Phone: <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 /O <br /> INVOICE / �� Account LONMWMMNMNNNN <br /> AR0034518 <br /> IFacility ID —FA—OO 19-4-1-1 <br /> Date Printed 4/28/2011 <br /> HARRELL, DAVID V RE : LODI MOTOR SPORTS <br /> 531 KANSAS AVE 847 N CLUFF AVE STE C <br /> MODESTO, CA 95354 LODI, CA 95240 <br /> OWNER : HARRELL, DAVID V <br /> Date Health Amount <br /> Program Description <br /> Invoice If IN0213787--Date of invoice: 113112011 I IIIIIII IIIIII III VIII VIII VIII ILII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII 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 lnvoic.j $ 142.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> Delinquent Charges <br /> will be forvvarded4o <br /> f' 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 1 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 />