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ENVIRONMENTAL HEALTH DEPARTME' — ' `I- ' <br /> 1868 E HAZELTON AVENUE ti ..i <br /> STOCKTON, CA 95205 1� <br /> INVOICE � Account ID AR0016508 <br /> COPY LMMMMENNOMMMMMill <br /> Facility ID FA0009508 <br /> Date Printed 5/30/2012 <br /> BONNIE L BERNEISER RE : GUARANTEE REPAIR SERVICE <br /> GUARANTEE REPAIR SERVICE 101 COMMERCE ST <br /> PO BOX 246 LODI, CA 95240 <br /> VICTOR, CA 95253-0246 <br /> OWNER : BONNIE BERNEISER <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223325---Date ofInvoice: 1/3012012 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIVIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 300.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 30.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total forthis in voice $ 805.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 805.00 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLEC`ti'9ONS <br /> in 30 days. <br /> Please make Checks PAYABLE to: 'EHO' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For DES I 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 />