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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF"'T Page 1 <br /> 600 E MAIN STREET- <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID F—AR-0-0 6-046 <br /> LMMMMMMMEMMI <br /> Facility ID FA0009046 <br /> Date Printed 2/28/2011 <br /> CALIFORNIA RADIATOR WORKS RE : CALIFORNIA RADIATOR WORKS <br /> PO BOX 159 328 S CALIFORNIA ST <br /> MOUNTAIN RANCH, CA 95246-0159 STOCKTON, CA 95203-3520 <br /> OWNER : FRANK BROCKMAN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0210660—Date of Invoice: 1/31/2011 11111 [IN <br /> 1128/2011 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 285.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> Total for this Invoice $ 547.00 <br /> �$@ Payment Due Date 3/2/2011 <br /> 'o 1 TOTAL DUE this Billing Periodl $ 547.00 <br /> C7 ! r� 'v <br /> t�-Z�7 <br /> r <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 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 />