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JAN JUAWUIN I.UUiN I T Page 1 <br /> .ENVIRONMENTAL HEALTH DEPARTMbow �I <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 ^ <br /> INVOICE �(�� AccountlD AR0016710 <br /> FacilitylD F FA0009710 <br /> Date Printed 5/30/2012 <br /> VALLEY SMOG & REPAIR RE : VALLEY SMOG Sr REPAIR <br /> 325 E KETTLEMAN LN #325 325 E KETTLEMAN LN 325 <br /> LODI, CA 95240 LODI, CA 95240 <br /> OWNER: KHAN, KASHIF <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223381 --Date of Invoice: 113012012 IIIIIIII IIIIII III VIII IIIIIIIIIIIIII IIIIIIIIIIIIIIIVIIII'I'I IIIIIIIIIIIIII IIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 100.00 <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 /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total forthis Invoice $ 585.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 585.00 <br /> PACEP' d D U E <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECTIONS <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 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 ea"c 0 Days thereafter <br />