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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 .f� AccountlD nRoolszsl <br /> �Cr p2 g 7�p Facility ID FA0009291 <br /> T Date Printed 5/27/2009 <br /> TED'S WELDING & REPAIR RE : TED'S WELDING & REPAIR <br /> PO BOX 726 8932 E HWY 12 <br /> VICTOR, CA 95253 VICTOR, CA 95253 <br /> OWNER : G WILLIAM BRAUN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184050--Date of Invoice: 1/29/2009 IIIIIIIIIIIIIVIIILIVI VIII VIVIIIIIIIIIIIIIIIIIII IIIIIIIII IIII <br /> 1/29/2009 2220 SM HW GEN <5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 285.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 763.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 763.50 <br /> RAISV��' <br /> Delinquent Charges <br /> will be forwarded to <br /> Ire 30 dabs. <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 I 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 />