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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM • Page 1 <br /> � <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE (� �q A oantlo ARoozozsl <br /> l Facility ID FA0012404 <br /> Date Printed 1 5/28/2008 <br /> LZMMMISMUMMUSNUM <br /> ROLLING FRITO LAY SALES RE : FRITO LAY INC <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# IN0170653 ---Date of Invoice: 1/25/2006 IIIIIIIII I III VII IIII III II IMI V IIV II I I VIII IIIIII I VI(IIII IIII <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 330.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2008 9987 Haz Mat Program Penalty Fee $ 33.00 <br /> 4/15/2008 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 /> f AST DUE <br /> Delinquent charges <br /> will be tonivarded to <br /> COLLECT` ONS <br /> do 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 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 />