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Page 1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF <br /> 600 E M444 STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0017623 <br /> Facility ID FA0010623 <br /> Date Printed 2/26/2010 <br /> SAM LUNG LAUNDRY INC RE : SAM LUNG LAUNDRY INC <br /> 742 E MAIN ST 742 E MAIN ST <br /> STOCKTON, CA 95202-3131 STOCKTON, CA 95202-3120 <br /> OWNER : TOY, SAM <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0198119--Date of invoice: 2/2/2010 111[fill IIIII IIIII IIIII11111111111111111111111 IN Hill 111 fill III <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <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 this Invoice _j_262 00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 262.00 <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 /> i3 rpt <br />