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OM14 4UMWU11Y 1,UUIV I T <br /> ENVIRONMENTAL HEALTH DEPARTMV Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR 6296291 <br /> Facility ID FA0009291 <br /> ` Date Printed F 5/28/2008 n11 <br /> . <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# IN0170149—Date of Invoice: 1/25/2008 I(IIIIII IIIIII III IIIII IIIII VIII VIII VIII VIII IIIII VIII VIII IIII 111111111111111 <br /> IIIIIIIIIIIIII IIII <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 315.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2008 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> 4/15/2008 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total forthis Invoice $ 796.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 796.50 <br /> PAST DUE <br /> Delinquent Charges <br /> will be forwarded to <br /> COLLECTIONS <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 />