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SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600E MAIN STREET OP ' <br /> STOCKTON, CA 95202 COPY'C <br /> INVOICE Account ID IF—AR0017813 <br /> Facility ID FA0010813 <br /> Date Printed 4/30/2012 <br /> B AND STRUCK WASH RE : B AND G TRUCK WASH <br /> 2904 CANYON DR 816 HWY 99 FRONTAGE RD <br /> MODESTO, CA 95351 RIPON,CA 95366 <br /> OWNER : SINGH,AMARJIT <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0224373---Date of Invoice: 113012012 I(IIII III IIIIIIII III(IIII IIII IIIIIIIIIIII II IIIIIIIII 111111 IIIA IIIIIIII <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 270.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9967 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice I $ 346.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 346.00 <br /> PAST DU <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECTRONS <br /> 6,,, in 30 days. • <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 f 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 />