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SAN JOAQUIN COUNTY Pae 1 <br /> ENVIRONMENTAL HEALTH DEPARTME' 9 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 U'U _ Zoos <br /> INVOICE CFFICEOFEMERGINUUUNRVICES Account 10 F AR0024993 <br /> Facility ID f FA 00 44 886 <br /> LINIMMEMMMMMMill <br /> Date Printed 5/23/2006 <br /> LOMMOMMENIMMENd <br /> CENTURY AUTO COLLISION RE : CENTURY AUTO COLLISION <br /> 3128 E FREMONT ST 3128 E FREMONT ST <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : NORMA CORTES <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0144404---Date ofInvoice: 1/27/2006 IIIIIIiI111111IIIIIIIIIIIIIIIIIIIIIAVIIIVIII1111111111VIIIIN111111111111111IN <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 255.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2006 9987 Haz Mat Program Penalty Fee $ 25.50 <br /> 4/15/2006 9994 PERMIT FEE PENALTY $ 200.00 <br /> Total for this Involcel $ 704.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 704.50 <br /> peimc�t�P <br /> \NW bE' ft` <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 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 />