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SAN JOAQUIN COUNTY ... "we ENVIRONMENTAL HEALTH DEPARTMENT Page 1 600 E MAIN STREET STOCKTON, CA 95202 Phone: (209)468-3420 INVOICE Account ID F AR0003451 Facility 10 F FA0003863 Date Printed f 1/30/2012 loommommommomms 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 IIII III'IIII�IIIIII IMI VIII VIII VIILI VIII IIII II IIII IIII IIII 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 Totalfor this Invoice $ 68.75 PAST DUE Invoice# IN0223626---Date of Invoice: 1/30/2012 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 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 Totalforthis Invoice $ 1,097.00 Payment Due Date 2/29/2012 TOTAL DUE this Billing Period $ 1,165.75 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