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03/01/2011 09:26 2094640138 AL HEALTH <br /> ENVIRONMENTAL HEALTH DEPARTMFMT RECERt Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 MAR — 1 2011 <br /> Phone: (209)468-3420 <br /> W JOAQUIN COUNTY ARDDz <br /> 1 NV w EMERGENCY SERVICI�<6 Axeunt ID —ssas <br /> Fadlty D PA00151009 <br /> Date Prtnled 21151'2011 <br /> PACIFIC COAST MS INDUSTRIES RE : PACIFIC COAST MS INDUSTRIES <br /> PO BOX 1020 3940 COMMERCIAL ST <br /> LEBANON, KY 40033-5020 TRACY, CA 95376 <br /> OWNER : PACIFIC COAST MS INDUSTRIES IN <br /> Date HeathT� <br /> Program Descon Amount <br /> Invoice# ING212337—Date of Invoice : 1131!2011 IIINIYd 01Ntl�llri911'I�I IIII�fI IIR gI�ISI MIIIII'11 MI <br /> 1/28/2011 2220 SM HW GEN<5 TONSPYR ��1p�l YY���I IIII�1 RY 44�I IIIIOOf�IN Al1I NNRSI Rlllltli 21300 <br /> 1282011 2244 2011 HAZMAT FEE $ 285.00 <br /> 1/28/2011 2398 UNIFIED PROGRAM FAC STATE SURCHARGE FEE S 24.00 <br /> 1I282D11 ERSC ELECTRONIC REPORTING SURCHARGE S 2500 <br /> Tow for tllie Imdce S 547.00 <br /> Payment Due Dale 32J2011 <br /> TOTAL DUE this Billing Period $ 547.00 <br /> o D <br /> FEB 28ZMi <br /> fNPERNRMf �S RYICEFNT $ <br /> Please make Checks PAYABLE to: 'END' – Return a Copy of This STATEMENT with Your PAYMENT <br /> Pena Ries 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 he added M the Rata of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days ager the Invoice Date 60 Days after the Invoice Data and each 30 Days ihemaftar <br /> 254.rP[ <br />