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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPA T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD <br /> `--AR0017987 <br /> Facility ID <br /> FA0010987 <br /> Date Printed it 2//28//2006 <br /> v <br /> PACIFIC COAST SUPPLY LLC RE : ANDERSON TRUSS <br /> ANDERSON TRUSS 2050 E LOUISE AVE <br /> 4290 ROSEVILLE RD LATHROP, CA 95330 <br /> NORTH HIGHLANDS, CA 95660 <br /> OWNER : PACIFIC COAST SUPPLY LLC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143140---Date of Invoice : 1/27/2006 11111111111111 H 111 11111 11111 11111 11111 11111 111 11111 11111 1111 111111 1111�1111 IN <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 315.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 539.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 539.00 <br /> Li <br /> RC��1lr��IJ <br /> FES 2 <br /> sAn,Jo 8 2004 <br /> L�; '`IQcran: <br /> y AON `cujh/T' <br /> � y�EpQgT��Nr <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 />