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ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET . <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE LVA Account ID AR00179D9 <br /> 1 � <br /> FacilitylD FA0010909 <br /> Date Printed 5/27/2009 <br /> CRAIG VEVODA RE . HUMBOLT CREAMERY ASSN <br /> HUMBOLT CREAMERY ASSN 1270 SHAW RD <br /> 572 HWY 1 STOCKTON, CA 95215 <br /> FORTUNA, CA 95540 <br /> OWNER : HUMBOLT CREAMERY INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0185288--Date of Invoice: 112912009 I IIIIII!IIIIII III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIIIII IIIII[III IN <br /> 1/29/2009 2221 USED OIL ONLY-<5 TONSIYR $ 54.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 270.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty �F2 $ 27.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY 54.00 <br /> t " .'( $ 54.00 <br /> Delinquent c�IargeS, Total for this Invoice $ 429.00 <br /> will bn iof'krfarded tO <br /> COLL <br /> ,1 aw y;�i{.i+IN,IS PAST DUE <br /> Invoice# IND189662--Date of Invoice : 5!2612009 �Q � sI IIIII1lIIIlII III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IlI11IIII11111111111[III IIII <br /> 5/26/2009 2245 ADDITION OF 2 CHEMICALS TO INVENTORY $ 30.00 <br /> Total for this tnvoice $ 30.00 <br /> Payment Due Date 612612009 <br /> TOTAL DUE this Billing Period $ 459.00 <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 <br />