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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0026987 <br /> Facility lD F FA0015622 <br /> Date Printed F 1/31/2011 <br /> GLORIA BALLESTEROS RE : DSJ CUSTOM CABINETS INC <br /> DSJ CUSTOM CABINETS INC 4843 E FREMONT <br /> 1844 E TENTH ST STOCKTON, CA 95215 <br /> STOCKTON, CA 95206 <br /> OWNER : PEREZ,DAVID/BALLESTEROS,GLORIA <br /> Date Health <br /> _Program Description <br /> Amount <br /> Invoice# IN0212402---Date of Invoice: 1/31/2011 111111111111111111 IN 1111111111111111111 <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <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 thla Involve $ 262.00 <br /> Payment Due Date 3/2/2011 <br /> / F ) TOTAL DUE this Billing Period $ 262.00 <br /> F r� <br /> J 0 <br /> 0 <br /> f, <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 Data 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />