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04/09/2012 16:41 2094640138 EM+1KUMltivlra� �� n <br /> SAN JOAQUIN COUNTY Page I <br /> ENVIRONMENTAL HEALTH DEPARTMEI ...! <br /> 600 E ARAM STREET _ % RECEIVED <br /> .>TOCKTON, CA 95202 <br /> Phone: (209)4683420 <br /> INVOICE <br /> APR — 9 201 ARoo,esz <br /> �Ib <br /> OFFICE OF EM RGENC�uNjM1ry1O FA0012236 <br /> °are Printed 31132012 <br /> KELLEY 13ROS BREWING CO RE: KELLEY BROS BREWING CO <br /> PO BOX 2466 112 E YOSEMITE AVE <br /> MANTECA,CA 55336-1166 MANTECA,CA 85336 <br /> OWNER : KELLEY,JOE N it <br /> Date Heafth <br /> Program Description ,r Amount <br /> inwica# IN022Ae04—Daft ofhwolce: 1=2012 <br /> 1272012 2244 2012 HAZMAT FEE Iw 1arrW� $ <br /> IN 93115.000 <br /> 127/2012 2398 UNIFIED PROGRAM FAC STATE SURCHARGE FEE :.: $ 24.00 <br /> 1?712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> tool brtlrY lmWc = 3G4.00 <br /> Paymont Due Dam 212912012 <br /> r—TOTAL DUE this Billing PWW s 364.00 <br />