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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 a prl� Account l0 ARoo20261 <br /> Facility ID FA0012404 <br /> Date Printed 5/27/2009 <br /> ROLLING FRITO LAY SALES RE : ROLLING FRITO LAY <br /> 4029 LECKRON RD 1190 SPRECKELS RD <br /> MODESTO, CA 95357 MANTECA, CA 95336 <br /> OWNER : FRITO LAY INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184542--•Date of Invoice : 1/29/2009 IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/29/2009 2220 SM HW GEN <5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 330.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 33.00 <br /> 4/1512009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoicel $ 813.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 813.00 <br /> tiT <br /> �� t OU e &,iges <br /> Ertl, 1,5. i')rNl�dFO � � <br /> adDad d�ays <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 DES/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 />