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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF"T <br /> 600 E MAIN STREET <br /> ON, 95202 <br /> Phone: 46 COPY <br /> Phone: (209) 468-3420 '� <br /> INVOICE � � '�J�� Account ID AR0032436 <br /> Facility ID FA0018389 <br /> LNUMMMUMMMMOM <br /> Date Printed 4/28/2011 <br /> POOL SUPPLIES & MORE RE : POOL SUPPLIES & MORE <br /> PO BOX 598 2127 E MOFFAT BLVD <br /> RIPON, CA 95366-0598 MANTECA, CA 95336 <br /> OWNER : AQUA POOL & SPA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0213516---Date of Invoice: 1/31/2011 1111111111111111111111111111 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 285.00 <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 Mat Program Penalty Fee $ 28.50 <br /> Total for this Invoice $ 362.50 - <br /> Payment Due Date 312/2011 <br /> TOTAL DUE this Billing Period $ 362.50 <br /> U <br /> E-1- <br /> DelinqUent charges <br /> will be fointfarded to <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 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 thereafter <br /> 5254.rpt <br />