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SAN JOAQUIN COUNTY IP Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> AMENDED Account ID AR0005769 '� <br /> INVOICE <br /> Facility ID FA0005307 <br /> Date Printed 2/17/2015 <br /> LINEEMEMMEMMMEMS <br /> LARRY MCMILLEN RE : HOLZ RUBBER CO <br /> HOLZ RUBBER CO 1129 S SACRAMENTO ST <br /> 1129 S SACRAMENTO ST LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : JRD RUBBER, INC. <br /> Date Health Amount <br /> Program Descriptlon <br /> Invoice# IN0260540---Date of Invoice: 1/29/2015 IIIIIIIIIIIVIIVIIIVIVIIIIIIIIVIIVIII VIIVIIIIIIIIVIIIIIII <br /> 1/29/2015 1921 HMBP-Regular-Primary Location $ 630.00 <br /> 1/29/2015 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00. <br /> 1/29/2015 APSA APSA SURCHARGE $ 26.00 <br /> 2/15/2015 9997 CORRECTION TO A CHARGE ($ 213.00) <br /> 2/17/2015 2247 RCRA GEN 5<25 TONS $ 1,672.00 <br /> Total for this Invoice $ 2,363.00 <br /> Payment Due Date 2/28/2015 <br /> TOTAL DUE this Billing Periodl $ 2,363.00 <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 HMBP 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 />