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SAN JOAQUIN COUNTY /57 /_f1//3 � <br /> ENVIRONMENTAL HEALTH DEPARTh,..rJT ✓ (` Page 1 <br /> 6C0 E .41AIN STREET <br /> STCCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0016775 <br /> LOMMMMUMNEMJ <br /> RECDRECDFacility ID FA0009775 <br /> F F"�} !�" 2 012 Date Printed 1/30/2012 <br /> CONCRETE INC RE : CONCRETEINC -STKN-STANISLAUS <br /> PO BOX 66001 749 S STANISLAUS ST <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER : CONCRETE INC <br /> Date Health <br /> - -- ^m3ram Des <br /> cnptien <br /> Invoice# IN0223402—Date of Invoice: 113012012 11111111111II VIIVIIVIII VVIVIVIIVIVIIIIIIIII 111111111 IIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 360.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> rTotal for this Invoice $ 622.00 <br /> Payment Due Date 2129/2012 <br /> TOTAL DUE this Billing Period $ 622.00 <br /> AMOUNT $ <br /> DEPT/GL # <br /> APPROVAL <br /> Please make Checks PAYABLE to: 'EHD' – Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be atltletl 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 atltletl 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 /> ,',4,pt <br />