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DUIjfZviI 10:L1 Lr1740401J0 oior <br /> SAN JOAQUIN COUNTY Page 1 <br /> cNVIRONMENTAL HEALTH DEPARTMEO <br /> 900 E MAIN STREET ED RECEIV <br /> STOCKTON, CA 95202 RECEIVED <br /> GLS <br /> Phone: (209) 468-3420 <br /> AR0032429 <br /> INVOICE <br /> SAN JOAQUIN COUNTY Facility ID FA00IS382 <br /> OFFICE OF EMERGENCY SERVICES <br /> Doi.PAnted 7!1312011 <br /> I� <br /> IOWA CORPORATE OFFICES I RE: HARPER BRUSH <br /> HARPER BRUSH 3632 PETERSEN RD STE <br /> 400 N SECOND ST STOCKTON, CA 95215 <br /> FAIRFIELD, IA 62556 <br /> OWNER: MIKE MOTTE7 <br /> Health Amount <br /> Dale program DOecnPhon ryry��I�lpp ��gy�I�I IIp�IIII a'1� qpI <br /> Invoice# IN0213512—Date of Invoice: 1/3 112 011 IIIIRIIII'I IM NNI�ININI'�IIIII,I'1I,loollow'111 <br /> $ 285.D0 <br /> 128/2011 2244 2011 HAZMAT FEE S 24.00 <br /> 1282011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 25.00 <br /> 1282011 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE g 28,50 <br /> 3/2012011 0987 Haz Mal Program Penalty Fee <br /> Total ror thlo lnvolce S 362.50 <br /> PAST DUE <br /> TOTAL DUE this Bfllingperlod $ 362.50 <br /> Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penailies will be added to a0 Permit Fees For OES/HMMP Fees penalties will be added at the Ram of 10% <br /> at the Rate of 1DW.of the Base Fee Penalties will be added at the Rate of 10°/. <br /> 3o Days after the Due Date 45 Days after the Invoice Date 60 Days atter the Invoice Data and each 30 Days thereafter <br /> 5254.rpt <br />