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ENVIRONMENTAL HEALTH DEPARTMENT raye i <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 ..l <br /> Phone: (209) 468-3420 <br /> INVOICE l 7 7 Account ID AR0016948 <br /> ✓ ( Facility ID FA0009948 <br /> LMMMOMMMMMMA <br /> Date Printed 5/27/2009 <br /> JOHN ROSSI HAY CO RE : JOHN ROSSI HAY CO <br /> PO BOX 332 511 N AIRPORT WAY <br /> MANTECA, CA 95336 MANTECA, CA 95336 <br /> OWNER : JOHN ROSSI <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184269--Date of Invoice: 1/29/2009 I IIIIIII IIIIII I VII IIII VIII VIII VIII VIII VIII VIII III I IIII III II I II II I III <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 315.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 796.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 796.50 <br /> V F. <br /> Delif Iquent Charges <br /> WN F-va lrirWat"d,c+�i €3 <br /> r i '.'F <br /> IFS 30 days. <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 />