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JMIY JVMWU111 uvun 1 r - Page 1 ENVIRONMENTAL HEALTH DEPARTMEI, 1868 E HAZELTON AVENUE STOCKTON, CA 95205 INVOICECUP,Y 1 _ Account ID AR0003451 Fadlity ID FA0003863 Date Printed 5/30/2012 DOMINGUEZ, MICHAEL RE : FREMONT SHELL* FREMONT SHELL* 2494 E FREMONT ST 2494 E FREMONT ST STOCKTON, CA 95205 STOCKTON, CA 95205 OWNER : DOMINGUEZ, MICHAEL Date Health Program Description Amount Invoice# IN0220314---Date of invoice: 10/24/2011 1111111111IN111111111111111p11 Hrs Employee 9/15/2011 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 WONG $ 62.50 1/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 2/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 3/15/2012 9988 SERVICE CHARGE PENALTY $ 6.25 Total for this lnvolce. $ 81.25 PAST DUE lnvolce# IN0223626--Date ofInvoice: 1130/2012 1111111111111111111111111111 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 1/27/2012 2244 2012 HAZMAT FEE $ 130.00 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 1/27/2012 2350 ADDITIONAL UST-2481 COMPLIANT $ 125.00 1/27/2012 2352 UST FACILITY&1 TANK-2481 COMPLIANT $ 550.00 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 3/15/2012 9987 Haz Mat Program Penalty Fee $ 13.00 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 4/15/2012 9994 PERMIT FEE PENALTY $ 550.00 4/15/2012 9994 PERMIT FEE PENALTY $ 125.00 Total for this Invoice $ 1,998.00 PAST DUE PAST 13 1 E TOTAL DUE this Billing Period $ 2,079.25 Delinquent charges will be forwarded to COLLECTIONS in 3o days. Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For OES/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