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SAN JQAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E MAIN STREET <br />STOCKTON, CA 95202 M E, CE ( Y ED <br />Phone: (209) 468-3420 til[ DIAI T . C A. "sT AP <br />INVOICE i ! FEB 23 PM 2:48 <br />I <br />Add►��S COQ ��-��►'� � �1 <br />�1 <br />Page 1 <br />Account ID AR0009076 <br />Facility ID FA0006696 <br />Date Printed L 1/31/2011 —; <br />CALIF NATL GUARD / COMBINED SUPPLY U RE: CALIF NATL GUARD / COMBINED SUPPLY <br />9800 GOETHE RD J 8020 S AIRPORT WAY <br />SACRAMENTO, CA 95827-3563 TTT""" STOCKTON, CA 95206 <br />-- ----- - -- OWNER: CALIFORNIA ARMY NATIONAL GUARD <br />Date Health <br />Program Description <br />Invoice # IND210566 -- Date of Invoice : 1/31/2011 <br />1/28/2011 <br />2244 <br />2011 HAZMAT FEE <br />1/28/2011 <br />2247 <br />RCRA GEN 5<25 TONS <br />1128/2011 <br />2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE, <br />1/28/2011 <br />ERSC <br />ELECTRONIC REPORTING SURCHARGE <br />Amount <br />$ <br />480.00 <br />$ <br />1,672.00 <br />$ <br />24.00 <br />$ <br />25.00 <br />Total for this Invoice $ <br />2,201.00 <br />Payment Due Date <br />3/212011 <br />TOTAL DUE this Billing Periodl 2,201.00 <br />PAYfo•'I E N T <br />RECEIVED <br />MAR - 3 2011 <br />SAN JOAQUIN COJNTY <br />EWRONMEN'TAL <br />HEALTH DEPARTMEW <br />Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT <br />)enalties 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 thereaftt <br />X294 rpt <br />