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-600 E MAIN STREET <br /> 'STOCKTON, CA 95202 <br /> Phone: (209)468-34200\ <br /> COPY <br /> INVOICE ` �� \ RECEIVED Account ID AR0017952 <br /> Facility ID FA0010952 <br /> SAN COUNTY <br /> JFFICE OF EM RGIE CY VICES <br /> Date Footed 5/26/2011 <br /> LAVAGNINO, EDWIN RE : E & A TIRE &AUTO REPAIR <br /> E &A TIRE & AUTO REPAIR 4304 E FREMONT ST <br /> 4304 E FREMONT ST STOCKTON, CA 95215-4020 <br /> STOCKTON, CA 95215 <br /> OWNER : E &A TIRE &AUTO REPAIR <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0210625---Date of Invoice: 1/31/2011 IIIIIII IIIIII IIIIII�I VIIIIIIIIIIIII VIIIIIIIIIIIII III'lllllll l'IIIII 1111111111111 <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 100.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2011 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 585.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 585.00 <br /> Re <br /> De31r3Cr,'Jer4 charges <br /> ,will be rOr,,,,riarded to <br /> %0 days- <br /> Please <br /> 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 />