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.+ e.pvv.�uwi • vvv •l i <br /> I ENVIRONMENTAL HEALTH DEPARTMF"IT Page 1 <br /> 000 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 �' <br /> Yjl <br /> INVOICE _i'', ��� �`� Account ID AROfl31479 <br /> X� <br /> Facility ID FA0017946 <br /> Date Primed 4/28/2011 <br /> US TRUCK TRAILER REPAIR RE : US TRUCK TRAILER'REPAIR <br /> 3833 DUCK CREEK DR 3833 DUCK CREEK DR <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : QAMAR HUSSAIN <br /> Date Health <br /> Program Description Amount <br /> Invoice 9 IND21342B-=-Date of Invoice : 1!3112019 I IIIIII IIIIIiIII IIIII VIII fIlil ll ll IIID IIIIIIIIII VIII VIII IIII IIIIi lllll llll lll� <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 285.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> Total for this Invoice $ 362.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 362.50 <br /> Will be, -ior v?sti de- to <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 1 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 atter the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and.each 30 Days thereafter <br /> 5254.rpt <br />