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SAN JOAQUIN COUNTY Page I <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> INVOICE Amount ID F—An0-17148-7,i <br /> Facility to F—FA-00-1-01-48—h <br /> Date Printed F-4/-30—/20-12-11 <br /> L <br /> TJ AUTO REPAIR RE: TJ AUTO REPAIR <br /> 4105 MIST TRAIL RD 1587 TURNPIKE RD <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER: HUYNH, HAI <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0224232--Date of Invoice: 1130/2012 IIIIIIII IIIIIII IIUIIVIIIIIIIIIIIIIIIIIIIIII IIII IIIIIIIIIIIIIII VIII 1111 IN <br /> 1127/2012 2244 2012 HAZMAT FEE $ 85.00$ 24.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 25.00 <br /> 1/2712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 8.50 <br /> 3115/2012 9987 Haz Mat Program Penalty Fee <br /> _ <br /> Total to,this Invoice j 14250j <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 142.50 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECT90 NS <br /> ii in 30 days. <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penalties will be added to all Permit Fees For OES I HMMP Fees Fo "SERVICE <br /> S <br /> 137 a T 1 0. penalties <br /> 81 , awl be added at the Rate of 10 <br /> O'Llelft" <br /> at the Rat.of Pa. t h <br /> w <br /> at tl s of 100./ of the I be added I Data and each <br /> 30 Days t <br /> he R ,Fe Pan it ',I <br /> 30 <br /> 't' - 0 a fthe Invoice <br /> Data 60 Day,after the <br /> Day, ft.,the Due at, Day'a ort <br /> 5254.rpt <br />