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ENVIRONMENTAL HEALTH DEPARTMENT <br /> X600 E MAIN STREET y <br /> 'STOCKTON, CA 95202 �•J <br /> Phone: (209) 468-3420 _ <br /> INVOICE Account ID AR0002335 <br /> Facility ID FA0002321 <br /> Date Printed 5/27/2009 <br /> <br /> <br /> <br /> STOCKTON,'CA 95206 <br /> OWNER : GILL, JODHA <br /> Date Health Amount <br /> Pro ram Description <br /> 9 <br /> I Invoice# IN0185454--Date of Invoice : 1129/2009 Ilgflll�Illll�IlI�I�III��IIl1�IiIlIIIIIlI�IlI11I�I1Il�lIIIIIIIIIifIi�lllllllil�ll�lllllll <br /> $ 213.00 <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 285.00 <br /> 1/29/20D9 2244 2009 HAZMAT FEE $ 15.00 <br /> l 1/29/2009 2301 UST STATE SURCHARGE FEE <br /> 1/29/2009 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 9/29/2009 2360 ADDITIONAL LIST $ 125.00 <br /> 1/29/2009 2362 UST FACILITY& 1 TANK $ 550.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 550.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 125.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 2,143.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 2,143.50 <br /> 1 <br /> I <br /> Delinquent charges <br /> Will be forwarded to <br /> ' <br /> in 30 days, <br /> i <br /> I <br /> Please make Checks PAYABLE to: 'EHD' Return a Copy of This STATEMENT with Your PAYMENT <br /> { For all SERVICE FEES <br /> Penalties will be added to all Permit Fees For OES!HMMP 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 46 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />