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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTNW Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Amount ID AR0017380 <br /> LMMMMMOMMMONON <br /> Facility ID —F­A0 110380 <br /> Date Printed 1/29/2009 <br /> KEYSTONE AUTOMOTIVE INDUSTRIES INC RE : KEYSTONE AUTOMOTIVE INDUSTRIES INC <br /> <br /> STOCKTON, CA 95206 <br /> OWNER : KEYSTONE AUTOMOTIVE IND INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0185184--Date of Invoice: 1/29/2009 111111111111111111111111 IN <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 285.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 522.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 522.0 <br /> PAYMENT <br /> RECEIVED <br /> FEB 9 2009 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 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 />