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SAN JOAQUIN COUNTY � Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMi�NT <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> INVOICE ('d AccountID AR0034959 <br /> \�� Facility ID FA0019630 <br /> ` Date Printed 4/30/2012 <br /> JACOBS, KELLIE A RE : VALLEY BREWING CO <br /> VALLEY BREWING CO 4950 W FREMONT ST <br /> PO BOX 77847 STOCKTON, CA 95203 <br /> STOCKTON,CA 95267 <br /> OWNER : VALLEY BREWING CO INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0226184---Date of invoice: 1/30/2012 11111 HEIIIII111111111111111111111111111111111111111IN <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 315.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/1512012 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> Total for this Invoice I $ 395.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 395.50 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <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 I 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 />