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JAN JUAI.IUIR t.UUN 1 T <br /> ENVIRONMENTAL HEALTH DEPARTMW Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 COPY <br /> INVOICE Account ID AR0016802 <br /> Facility ID FA00098 22 <br /> Date Printed F 3/30/2011 <br /> IfO7—E— AbDi�ss p� j—, X <br /> INJECTION MOLDING CORPORATION RE : INJECTION MOLDING CORPORATION <br /> 922 INDUSTRIAL WAY STET,/ 922 INDUSTRIAL WAY STEX K <br /> LODI, CA 95240 �\ _ I �\ LODI, CA 95240 <br /> OWNER : INJECTION MOLDING CORPORATION <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0211796—Date of Invoice: 1/31/2011 11111111111111 HE 1111111111111111111111111111111111 IN 111111111111111 IN <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 100.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> Total forthis Invoice $ 372.00 <br /> Payment Due Date 312/2011 <br /> TOTAL DUE this Billing Period 372.00 <br /> I �J,Q,,fv1--' 1,1-� iVq Ue <br /> r QTI <br /> Hn';;. .�• PAYMENT <br /> PrCEIVED <br /> APR 121011 <br /> '—oUfM COUNry pp <br /> °_'aEIEN �Ki <br /> M1"EM <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 /> 5254spt <br />