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JAN .!UAULJIN I:UUN I T <br /> ENVIRONMENTAL HEALTH DEPARTMr"'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTOfv', CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0027290 <br /> Facility ID LIM <br /> FA0015758 <br /> Date Printed 1/26/2007 <br /> VAN DE POL ENT INC-PRIMARY RE : VAN DE POL ENT INC-PRIMARY <br /> <br /> STOCKTON, CA 95206 <br /> OWNER : VAN DE POL ENTERPRISES INC. <br /> Date Health <br /> Program Descriotion ' Amount <br /> Invoice# IN0158409---Date of Invoice: 1/25/2007 11111 1111 111111 11111 IN IN <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 390.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 620.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 620.00 <br /> n <br /> L� <br /> vOvtJN <br /> h JOPQUtN �jA►- <br /> SP evvkHk <`P 5"W0 C <br /> k1�t`Tt{D_ <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 />