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. + SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT � Page i <br /> 600 E STREETC'80,1EPT <br /> STOCKTON, CA 95202 ' <br /> Account ID AR0005A51 <br /> Facility 10 FA0005008 <br /> Date Printed F4130/2012 <br /> PCI-PAINTING RE : PC]-PAINTING <br /> 620 SAN JUAN AVE 620 N SAN JUAN <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 <br /> OWNER : PCI-PAINTING <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0225993---Date of Invoice: 113012012 I IIIIIIIIIIIII III Illll Illlllllll IIIII Illlllllllllllllllll illllllllillllllllll IIIIIIII <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 255.00 <br /> 1/2712012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 112712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 25.50 <br /> Total For this Invoice $ 329.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 329.50 <br /> PAST arC)"U <br /> Delinquent charges <br /> will be forwarded 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 OES 1 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 pays after the Invoice Date 60 Days after the Invoice fate and each 30 Days thereafter <br /> 5254.Tpt <br />