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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME- <br /> 600 E MAIN STREET _ <br /> STOCKTON, CA 95202 -A 7D 7 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016876 <br /> FacilityID FA0009876 <br /> Date Printed 2/2/2010 <br /> DEJONG, BLAINE RE : BLAINE DEJONGS AUTO WORKS INC <br /> BLAINE DEJONG'S AUTO WORKS INC 324 N CLUFF AVE <br /> 324 N CLUFF AVE LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : BLAINE DEJONG'S AUTO WORKS INC <br /> Date Health <br /> Program Description Amount <br /> Imrolce# IN019T924—Date of Invoice: 2/2/2010 IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 130.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> Total for tnis Invoice $ 392.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 392.00 <br /> To vN r'I v M I T M A L E2N <br /> J <br /> 13 AIvE De JoN b'S /}{;jd WORDS //JC, /S Ko LG/.I (.E'A /IV 43ct5/,VCSS ANQ HAS NOT <br /> �jEEu //V BCtS/NESS S/N GES e/0% T//E /VZ7IN TE/V^vANT AT <br /> 3i41 A. /V. C /L fLE / S 7 *P A"7o WORkS .4 S�OG. TNEr2 - .P.Wov #�S <br /> 2oq _ 33y- 6332 . <br /> FEB 2 g 2010 <br /> ENVIRONMENT HEALTH <br /> KRMIT/SERVICES <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/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 />