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LNVIRONMENTAL HEALTH DEPARTIV T <br /> 600 E MAIN STREET Page <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE <br /> Account ID AR0005863 <br /> Facility ID f FA0005396 <br /> Date Printed 1/29/2009 <br /> BRUCE &JACK <br /> <br /> STOCKTON, CA 95202 <br /> OWNER : LA BERGE, JACK <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0183932---Date of invoice: 1/29/2009 1 MIT 11111111111111111111111111111111111111111111111111111111111111111111111111111 <br /> 1/29/2009 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 130.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> [ Total for this Invoice $ 367.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period <br /> PAYMENT <br /> RECEIVED <br /> FEB 0 9 2009 <br /> sAN <br /> EjoAQUIN <br /> HEALTH DEPARTMENT <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 DES/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 /> =a rpt <br />