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r+. .vr WuuY \ UUINI I <br /> ENVIRONMENTAL HEALTH DEPARTMENT RECEIVED Page 1 <br /> 600 E MAIN STREET <br /> 'STOCKTON, CA 95202 APR 2 0 2009 v <br /> Phone: (209)468-3420 <br /> FICEOFEMER;IE CYSERVICES <br /> INVOICE Account ID LUMAR0018276 <br /> MMIll <br /> N 5� Facility ID FA0011276 <br /> llll Date Printed F 3/25/2009 <br /> INOMMUMMMMMEMA <br /> SIMPLE DESIGNS MFG RE : SIMPLE DESIGNS MFG <br /> PO BOX 2136 1627 ARMY CT 1 <br /> WILSONVILLE, OR 97070 STOCKTON, CA 95206 <br /> OWNER : SIMPLE DESIGNS MFG <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0185427—Date of Invoice: 1/29/2009 11111111111111111111 IN IIIIII IIIII IN IIII <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 270.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice $ 321.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 321.00 <br /> U <br /> Delinquont charges <br /> will be ort,!vardvd to <br /> Air 3Q da.Vs. =.; <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 />