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SAN JOAQUIN COUNTY <br /> EN'iiRONMENTAL HEALTH DEPARTMF^IT <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE /? J� Amount ID AR0033759 <br /> Facility to FA0018979 <br /> LOMMMMMMEXAPPA <br /> Date Printed 4/28/2011 <br /> CV FABRICATORS INC RE : CV FABRICATORS INC <br /> <br /> MANTECA, CA 95336 <br /> OWNER : CV FABRICATORS INC <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0213623---Date of invoice: 1/3112011 11111IE11111111111111111111111 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 345.00 <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 $ 34.50 <br /> r— Total for this Invoice $ 428.50 <br /> Payment Due Date 311/2011 <br /> TOTAL DUE this Billing Period $ 428.50 <br /> Delinquent charges, <br /> will be forwarded to <br /> 00 { 0 <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/HMMP Fees For all SERVICE FEES <br /> at the Rate of 1 DO%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 />