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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP�tRTME o Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0004379 <br /> Facility ID I FA0002387 <br /> Date Printed 1/30/2006 <br /> KEYSTONE AUTOMOTIVE INDUSTRIES INC RE : KEYSTONE AUTOMOTIVE INDUSTRIES INC <br /> 632 S EL DORADO ST 632 S EL DORADO ST <br /> STOCKTON, CA 9203-3407 STOCKTON, CA 95203 <br /> OWNER : KEYSTONE AUTOMOTIVE IND INC <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0143091 ---Date of Invoice: 1/27/2006 11111111 EIII III IIIII IIIII IIIII IIIII 11111 11111 111 11111 11111 1111 111111 11111 1111 IN <br /> 1/27/2006 2220 SM HW G�N<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 300.00 <br /> 1/27/2006 2399 UNIFIED F ROGRAM FAC STATE SURCHARGE FEE $ 24. <br /> Total for this Invoice $ 524.00 <br /> Payment Due Date 3/1/20 <br /> TOTAL DUE this Billing Period $ 524.00 <br /> PAYMEN l <br /> RECEIVED <br /> FEB 15 2006 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks P YABLE 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 /> �254.rpt <br />