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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMPT <br /> 600 E MAIN STREET f COPY <br /> STOCKTON, CA 95202 J. <br /> INVOICE Account l0 AR0032430 <br /> Facility ID F FA001 3-83 <br /> Date Printed 4/30/2012 <br /> J&B AUTO BODY RE: J&B AUTO BODY <br /> 2200 W COUNTRY CLUB BLVD 2200 COUNTRY CLUB BLVD <br /> STOCKTON,CA 95204 STOCKTON,CA 95204 <br /> OWNER : JOHN FULLER <br /> Date Health <br /> Program Description Amount <br /> Invoice# ING225937---Date of invoice: 113012012 IIIIIIIIIIIIIIIIIIIIIIIIIIIVIIVIIIIIIIIIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 270.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/2712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this lnvolce $ 346.00 <br /> PAST DUE <br /> TOTAL DUEthis Billing Period $ 346.00 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECT90NS <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 OES/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 />