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SAN JOAQUI% COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600E MAIN STREET COPY <br /> STOCKTON, CA 95202 ✓1 <br /> INVOICEy�' 1 ;/ Account D FAR0033759 <br /> Facility ID FA0018979 <br /> Date Printed 4/30/2012 <br /> CV FABRICATORS INC RE : CV FABRICATORS INC <br /> <br /> MANTECA, CA 95336 <br /> OWNER: CV FABRICATORS INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0226040---Dateofinvoice: 113012012 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIIIIIIIIIIVIIIINIIIIIIIIIIIIIIIIN <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 345.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 112712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 34.50 <br /> Total for this Invoice $ 428.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 428.50 <br /> PAST 13UE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECT9ONS <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 Rafe 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 />