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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM Page 1 <br /> 1868 E HAZELTON AVENUE f <br /> STOCKTON, CA 95205 <br /> INVOIC Account ID —AR 0016948 <br /> COPY <br /> Facility ID FA0009948 <br /> Date Printed 5/30/2012 <br /> A &A ROSSI HAY SERVICE RE : A &A ROSSI HAY SERVICE <br /> PO BOX 332 511 N AIRPORT WAY <br /> MANTECA, CA 95336 MANTECA, CA 95336 <br /> OWNER : A&A ROSSI HAY SERVICE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IND223449—Date of Invoice: 1/30/2012 VIII IIII III VIIIVIIIVIIIVIIIVIII VIIIIIII IIIVIII IIIIIIIIIIIIIIVIIIA IIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 315.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 675.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 675.00 <br /> Total forthis Invoice $ 2,171.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 2,171.50 <br /> PASS' 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 /> 5254spt, <br />