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SAN JUAUUIN GUUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTMPage t <br /> V# <br /> 600 E MAIN STREET <br /> Phone: ON,209 46 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0028316 <br /> D LIBROMMMMMOMMA <br /> Facility ID FA0016193 <br /> Date Printed 4/24/2009 <br /> �aa�ms— -- <br /> CAR QUEST RE : CAR QUEST <br /> 1645 E MINER AVE 1645 E MINER AVE <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : GOLDEN STATE SUPPLY <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0185863---Date of Invoice: 1/29/2009 I VIII�II I III VII IIIIIII I VII V I(III VIII I II 'lIf VIII 1111111111111 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 255.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 25.50 <br /> 4/6/2009 9999 PAYMENT ($ 279.00) <br /> PENALTY Or`�,r! NG Total for this Invoice $ 25.50 <br /> 1 OWING` 'l./ Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 25.50 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <br /> C,OL EC IONS <br /> it 3 dav;~, <br /> RECEIVED <br /> APR 2 5 2309 <br /> OFFICE OFEMERGENCY SERVICES <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.mt <br />