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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID —AR 0016948 <br /> Facility ID FA0 009 448 <br /> mommom <br /> Date Printed 4/23/2013 <br /> INNEEMENNEENOMM <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 /> Health <br /> Program Description Amount <br /> Date <br /> Invoice# IN0236102---Date of Invoice: 2/1/2013 IIIIIIIII VIIVIIIVIIVII VIIIVII VIIVIIIVII VIIIIIIIVI IIIIII <br /> 2/1/2013 1921 HMBP-Regular-Primary Location $ 345.00 <br /> 2/1/2013 2220 SM HW GEN<5 TONS/YR S 213.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE S 35.00 <br /> 2/1/2013 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 675.00 <br /> Total for this Invoice $ 1,268.00 <br /> Payment Due Date 3/3/2013 <br /> TOTAL DUE this Billing Period $ 1,268.00 <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 HMBP 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 /> ->J.rpl <br />