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,Y, Vr��V11Y VVUIYI I <br /> ENVIRONMENTAL HEALTH DEPARTMF"'T Page 1 <br /> 600 E MAIN STREET *.r %we <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR000 4451 <br /> LUMMOMMMMMME <br /> Facility ID FA0003863 <br /> LIMENEMMMMEMMIll <br /> Date Printed 4/28/2010 <br /> DOMINGUEZ, MICHAEL RE : FREMONT SHELL* <br /> FREMONT SHELL* 2494 E FREMONT ST <br /> 2494 E FREMONT ST STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 <br /> OWNER : DOMINGUEZ, MICHAEL <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0198128--Date of Invoice: 2/2/2010 11111111111111111111 IN IIIII 111111111 IN <br /> 2/1/2010 2220 SM HW GEN <5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 130.00 <br /> 2/1/2010 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 2/1/2010 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 2/1/2010 2350 ADDITIONAL UST-2481 COMPLIANT $ 125.00 <br /> 2/1/2010 2352 UST FACILITY 8 1 TANK-2481 COMPLIANT $ 550.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 13.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 550.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 125.00 <br /> Total for this Invoice $ 1,998.00 <br /> Payment Due Date 3/4/2010 <br /> PAST D TOTAL DUE this Billing Period $ 1,998.00 <br /> Delinauent charges <br /> will be forwarded t0 <br /> CC)LLECM0NS <br /> #� irl. 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 DES/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 />