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:1/lU Z00t) U`J:2D 4b,101 38 ENV111.MNLNIAL HEALTH PAGE 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPAF ENT rri Pa <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone; (209)4683420 <br /> INVOICE RECEIVED Account 11) AR0028324 <br /> 1 2005 F.AtyID FAW16201 <br /> 1 [ OFFICE OF EMA RGIENCY SERVICE. <br /> fT l ` I � S Dale Pdmea 8/26/2005 <br /> GARCIA'S AUTO REPAIR& TOW RE : GARCIA'S AUTO REPAIR 6 TOW <br /> 962 E WATERLOO RD 982 E WATERLOO RD <br /> STOCKTON,CA 95206 STOCKTON,CA 95206 <br /> OWNER : EVARISTO LUNA GARCIA <br /> Date Health <br /> Program Detcrotion Amount <br /> Invoice 0 IN0134091—Date of llwoloe: 6/23/2005 I�flMIi 1M11��N11IlOGIt1191�1911011 MN�11A11111 M111�� <br /> 523/2005 2244 2005 HAZMAT FEE Pt tIS 4 YEARS BACK BILLING $ 425.00 <br /> 5232005 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 7/152005 9987 Har Mat Program Penalty Fee $ 42.50 <br /> Total for INS It ce f 491.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 491.50 <br /> PAST DUE <br /> Delinquent charge-s- <br /> will <br /> hargeswill be forwarded to <br /> COLLECTIONS <br /> in ZQ days. <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> penaltlas will be added to all Parmlt Pees For OES/HMMP Fast For all SERVICE FEES <br /> at the Rate M 100%of the Bate Fan Penalties will be added at the Rate of IG% Penalties will be added at the Rate of 10% <br /> 3D Days after the Due Date 45 Days after the Involce Date 60 1350 alter the Invoke Data and each 30 Days thereafter <br /> Ct CS rot <br />