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oMlldWnWUlll I UUIVI T <br /> ENVIRONMENTAL HEALTH DEPARTMW Page <br /> •600 E MAIN STREET • <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE 1�\`;`� ' Amount AR0024995 <br /> Facility ID FA0014688 <br /> Date Printed 4/28/2011 <br /> HALL, CLIFF RE : DANS TIRE &AUTO REPAIR <br /> DANS TIRE&AUTO REPAIR 1533 S STOCKTON ST <br /> 1533 S STOCKTON ST LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : HALL, CLIFF <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0212270---Date of Invoice: 1/3112011 IIIIIIIIIIIIIIIIVIIIVIIIVIIIVIIIII VIIIVIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 115.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 11.50 <br /> Total for this Involce $ 175.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 175.50 <br /> L4AS T 10 <br /> Delinquent choarges <br /> will he fcr marded to <br /> CUn—L E,i!TP0e 3 <br /> in 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 />