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ENVIRONMENTAL HEALTH DEPARTMENT <br /> _600 E MAIN STREET <br /> 11-10,STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID ARoo,ssos <br /> Facility ID FA0009508 <br /> ( Date Panted F 5127/2009 <br /> BONNIE L BERNEISER RE : GUARANTEE REPAIR SERVICE <br /> GUARANTEE REPAIR SERVICE 101 COMMERCE ST <br /> PO BOX 246 LODI, CA 95240 <br /> VICTOR, CA 95253-0246 <br /> OWNER : BONNIE BERNEISER <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN01a4134--Date of invoice: 1129/2009 IIIIIIIIIIIIIIIIIIIIVIIVIIIVIIIVIIVIIIVIIVIIIIIIIIIIIIIIIIININ <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 300.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 30.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 780.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 780.00 <br /> Delinquent Charges <br /> will be forwarded to <br /> CMLECTIIONS <br /> irr, 30 Slays. <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 DES!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 110% <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 />