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JAN.JUAWUIN I:UUN I Y Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMEM • <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE 6 5 'i Account ID AR0022731 <br /> Facility ID FA0013597 <br /> Date Printed 3/31/2010 <br /> RALPHS STATUARY RE : RALPHS STATUARY <br /> 3741 TINA PL 3602 E MUNFORD AVE <br /> STOCKTON, CA 95215-1109 STOCKTON, CA 95215 <br /> OWNER : LOMELI, RALPH <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0199138---Date of Invoice: 2/2/2010 IIIIII IIIVIIVIIIVIIVI VIIIVIIIIIV I VIII IIII IIIIII IIIII IIII IIII <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 255.00 <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 $ 25.50 <br /> Total for this Invoice $ 329.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 329.50 <br /> a :h[gew <br /> in 30 daYS. 2 <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 OES/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 />