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02/13/2010 15:14 2094640188 ENVIRONMENTAL HEAITH PAGE 01/01 <br /> SAN JOAQUIN COUNTY f Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 96202 <br /> Phone: (209) 468-3420 <br /> Account 10AROQ17 660 <br /> INVOICE <br /> Facility ID FAOO10960 <br /> Date printed 2118!201 D <br /> HERTZ EQUIPMENT RENTAL-FC RE : HERTZ EQUIPMENT RENTAL -FC <br /> 11285 VALLEJO CT <br /> FRENCH CAMP,CA 95231 <br /> 500 COMMERCE BLVD. <br /> ROHNERT PARK, CA 94928 OWNER . HERR CORPORATION <br /> Health Amount <br /> Date Progr9M pescriptlon II II pp 11nn mm 11I (( pnn II�jI{{I Il 111111 n <br /> ll IP IN <br /> Invoice# IN0198231 --Date oflnvoice: 2!2!2010 I1I��I��III�I�IIIIIIII�IIIIIIIIV�IIIIIIIII�I�IIIIIII�IIII�IIII '"�1.S. 0 <br /> $ 213.00 <br /> 2/1/2010 2220 SM HW GEN<5TONS/YR $ 375.00 <br /> 211/2010 2244 2010 HAZMAT FEE $ 24.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 337 00 <br /> 2/1/2010 2832 AST FAC 10 K-<I=100 K GAL CUMULATIVE $ 25.00 <br /> 2/112010 ERSC ELECTRONIC REPORTING SURCHARGE �$ 337.00) <br /> 2/15/2010 9997 CORRECTION TO A CHARGE <br /> Total fofthls Invoice $ 637.00 <br /> Payment Due Date 31 10 <br /> TOTAL DUE this 6111ing Period $ 637.00 <br /> PAYMENT <br /> RECENED <br /> � MAR082010 <br /> y,H jor+aun+count y <br /> OCARONME»Tri. <br /> tEALTM aEpkRTMEKT <br /> Please make Checks PAYABLE to: 'EHD' Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penalties will be added to all Permit Fees For OES I HMMP Fees penalties will be added at the Rate of 10"/0 <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rata of 10% 60 Da s after the Invoice Date and each 30 Days thereafter <br /> 30 Days after the Due Date 45 Days after the Invoice Date Y <br /> 525 4.rpt <br />