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")AIV JUF1l,tU1N UUUNi T <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 000 E MAIN STREET . <br /> SfOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> ;fes <br /> INVOICE l f�' ')� Account ID AR0005451 <br /> Facility ID FA0005008 <br /> Date Printed 4/28/2011 <br /> PCI-PAINTING RE : PCI-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# IN0213574---Date of Invoice : 11311201, 1111111111ITIIN11111111111HIIIN <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 255.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1128/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 25.50 <br /> Total for this Invoice $ 329.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 329.50 <br /> $ I C 3401 d , <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 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt b <br />