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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTN NT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0017273 <br /> lammmmmmommmm <br /> Facility ID FA0010273 <br /> Date Printed F 1/31/2011 <br /> LICENSING RE : COSTCO WHOLESALE -MEATS#210 <br /> <br /> <br /> <br /> : COSTCO WHOLESALE CORP <br /> Dale Health <br /> Program Description <br /> Amount <br /> Invoice# IN0210616---Date of Invoice: 1/31/2011 IIIIIIIIIIVIVIIVIIIVIIIVIIIIIIIIIIIVIIIIIIIIIIIIIII IIIIIIIIIIIII <br /> 1/28/2011 2214 CaIARP FAC STATE SURCHARGE FEE $ 270.00 <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 510.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1128/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> Total for this Invoice $ 1,042.00 <br /> Payment Due Date 30".2011 <br /> TOTAL DUE this Billing <br /> , 7 <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 />