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ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET U <br /> STOCKTON, CA 95202 �/ f <br /> Phone: (209)468-3420 <br /> INVOICE FE5 _1 i 2PP Account ID AR0022618 <br /> ,n�q <br /> Facility ID r FA0013514 <br /> BY:----------- <br /> Date Printed 2/9/2009 <br /> IMEMMEMMMMOMME <br /> COLLICUT ENERGY SERVICES INC RE : COLLICUT ENERGY SERVICES INC <br /> 940 RIVERSIDE PKWY STE 80 3955 E ARCH RD <br /> WEST SACRAMENTO, CA 95605 STOCKTON, CA 95215 <br /> OWNER : COLLICUT ENERGY SERVICES INC <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN01 84601 --Date of Invoice: 1/29/2009 IIIIIIIIIIIIIIIII VIIIIIIIIIIIII VIII VIII VIIIUIII VIII VIIIIIII II'III IN 1111 <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR fl $ NNA 21113.A00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 330.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 567.00 <br /> Payment Due Date <br /> TOTAL DUE this ' i erio 567.00 <br /> RFCEi�/ED <br /> n0 f I10 , - 5:1C MAR 2 3 2009 <br /> _34i N - SAN JOAQUIN COUNTY <br /> !!! ENVIRONMENTAL <br /> � _ HEALTH DEPARTMENT L/ <br /> 1'Y (S. y/� �lo�04 JAHyvK 7Lry`a �I YNP J&,4GC tt)t hi 41?e <br /> f`�If1�/, t415 �1iSCu5(CU_ - - jt� w7orletl UUP S I� CYi�I� JrCi� <br /> 4u /' <br /> // II / �r9rJ( 9� 44C d1 �C to <br /> �pTt�n tuie <br /> I"C1 <br /> PAf045S6e/Cr Ad Ally ou/ <br /> 16 0100L) 1 6 SAG/fl1'`',,e/I N, 1 "V <br /> HO,64- -rtV4-�r,, vluu/ �f 1 �Mvl <br /> 2o,-`IS3 bo�oo IfRZ M44 P(no,�C 133g3 <br /> Please make Checks PAYABLE to: 'EHD' - Return a Copy of 4h TA76!� <br /> rteN Your P YMENT���i�� <br /> ' <br /> Penalties will be added to all Permit Fees For OES I 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 />