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SAN JUAUUIN 1,UUN1 T raye t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE 'd- Account 1D AR0017601 <br /> Facility ID FA0010601 <br /> LOWMEMMMMMMIll <br /> Date Printed 4/28/2011 <br /> AQUA POOL &SPA RE : AQUA POOL& SPA <br /> PO BOX 598 1869 MOFFAT BLVD <br /> RIPON, CA 95366-0598 MANTECA, CA 95336-9702 <br /> OWNER : TOWNSEND, RICHARD <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0211878---Date of Invoice: 1131/2011 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIi�IIIIIIIIII VIII VIIIVIIIIIII IIII'VIIIIIIIIIII <br /> 1/28/2011 224.4 2011 HAZMAT FEE $ 345.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mal Program Penalty Fee $ 34.50 <br /> Total for[his Invoice $ 428.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 428.50 <br /> AST <br /> Delinquent charges <br /> Will be for yarded to <br /> 00,U.F CT10'5 w 3 <br /> s ... ir. 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 I 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 thereaker <br /> 5254.rpt <br />