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0ft1v,wAWU1ry t UUN f r _ gage i <br /> ENVIRONMENTAL HEALTH DEPARTME-N T� ! <br /> 500 E MAIN STREET L� V <br /> STOCKTON, CA 95202 <br /> COPYRhone <br /> : {209} 468-3420 <br /> INVOICE Account ID AR0033302 <br /> Facility ID FA0018757 <br /> Date Printed 3/31/M 0 1 0 <br /> MOONLIGHT AUTO RE : MOONLIGHT AUTO <br /> 2560 S ELDORADO ST 2560 S EL DORADO ST <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER . JOSE ROMERO <br /> I <br /> Date Health <br /> Program Description Amount <br /> invoice# IN0200669---Date of lnvoice: 212/2010 IIIIlI111111I1IIf lIIIIIIIII IllllIIIII IIIII IIIII IIIIIIIIII IIIIIIIII Il1lll IIIII IIIIIIII <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85'00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE" $ 25.00 <br /> f 3/20/2010 9987 Haz Mat Program Penalty Fee $ 8"50 <br /> I Total.forthis Invoice '-$-142.50 <br /> Payment Due Date 3/412010 <br /> TOTAL DUE this Billing Periodl $ 142.50 <br /> i <br /> Delia <br /> wilt b8a '�'OVVV`f <br /> I • <br /> fir"—Q ?� <br /> t, <br /> i <br /> 1 <br /> Please make Checks PAYABLE to: 'EHD' _ Return a Copy of This STATEMENT with Your PAYMENT <br /> i 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 Hays thereafter <br /> i <br /> i 5254.rpt <br /> i <br />