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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME Page 1 <br /> ' <br /> 600 E MAIN STREET 4111 <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountiD r AR0017096 <br /> Facility ID FA0010096 <br /> Date Printed 2/10/2009 <br /> BROOKSIDE GOLF&CC INC RE : BROOKSIDE GOLF&COUNTRY CLUB <br /> 3603 ST ANDREWS DR 3130 BROOKSIDE RD <br /> STOCKTON, CA 95219 STOCKTON, CA 95219 <br /> OWNER : BROOKSIDE GOLF &COUNTRY CLUB <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184305—Date of Invoice: 1/29/2009 IIIII IN IIII <br /> 1/29/2009 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 420.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 657.00 <br /> Payment Due Date 2/28/ <br /> TOTAL DUE this Billing Period $ 657.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 9 2009 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <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 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 />