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SAN JOAQUIN COUNTY Page 1 ENVIRONMENTAL HEALTH DEPART JT 1868 E HAZELTON AVENUE STOCKTON, CA 95205 INVOICE Account ID AR0025003 Facility ID FA0014696 Date Printed 11/19/2012 V&J ORNAMENTAL IRON WORKS RE : V&J ORNAMENTAL IRON WORKS 1201 N FILBERT ST 1201 N FILBERT ST STOCKTON, CA 95205 STOCKTON, CA 95205 OWNER : VICTOR RIVARN /JAIME SALAS Date Health Program Description Amount Invoice# IN01 93907--Date of Invoice: 9/2412009 �L �(��y p�I1IIIIIIIII VIVIIVIIIVIII VIII1I1I1VII IIDVIIIIII 111111111111111 IIII 9/24/2009 2244 2012 HAZMAT FEE �"��J�`("'/ b0�7� $ 1 445,50 11/15/2009 9987 Haz Mat Program Penalty Fee Total for this Invoice $ 1,567.50 PAST DUE Invoice# IN0199284---Date of Invoice: 2/2/2010 IIIIIII 111111 III VIII IIIII IIIII IIIII IIIII IIIII11111111111111111111111111111111111111 2/1/2010 2244 2012 HAZMAT FEE $ ?ia , o 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 211/2010 ERSC ELECTRONIC ING POR 3/20/2010 9987 Haz Matt Progr mEPee arty Fee SURCHARGE,I_ �Z� $ 25.00 �F OO Total forthis Invo e § 2.50 PAST DUE Invoice# IN0212274—Date of Invoice: 1/31/2011 IIIIIII111111IIIlIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII 1111 IN 1/28/2011 2244 2012 HAZMAT FEE $ 285.00 1/28/2011 2399 UNIFIED PROGRAM FAC TATE SURCHA GE FEE $ 24.00 1/28/2011 ERSC ELECTRONIC REPORTING TATE SURCHARGE FEE S 25.00 3/20/2011 9987 Haz Mat Program Penalty Fee 2 q �p y $ 28.50 / D J Total for this Invoice $ 362.50 PAST DUE TOTAL DUE this Billing Period $ 2,292.50 Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For DES/HMMP Fees For all SERVICE FEES 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 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter 5254.rpt