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ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 ' 1 COPY <br /> INVOICE b Account ID r AR0016870 <br /> LENNoffmmmmmmma <br /> Facility ID FA0009870 <br /> Date Pnnted 3/31/2010 <br /> Inommomemommmumil <br /> FOREST LAKE GOLF COURSE RE : FOREST LAKE GOLF COURSE <br /> 2450 E WOODSON RD 2450 E WOODSON RD <br /> ACAMPO, CA 95220-9646 ACAMPO, CA 95220 <br /> OWNER : MARGARET J RING <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0198858---Date of Invoice: 2/2/2010 IIII II III I III VIII VIII V I VII VII V I V II VIII VIII II I I II 1111111111111 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 315.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> Total for this Invoice $ 395.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 395.50 <br /> PASS <br /> ()ejjncl caj-tt cnen,, « <br /> wdi t-)C' <br /> 4 ::Zj <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 />