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JAN JUAt.(UIN t:UUN I Y Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMERT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> 'NVOIC Account ID AR0016362 <br /> COPY FA0009362 <br /> A FaciliryID <br /> Date Printed 5/30/2012 <br /> JIM DONALDSON RE : JFD RETYRE INC <br /> JFD RETYRE INC 240 N HUNTER ST <br /> PO BOX 778 STOCKTON, CA 95202 <br /> STOCKTON, CA 95201 <br /> OWNER : JFD RETYRE INC <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0223268...Date of Invoice: 1/30/2012 IIIIIIII IIIIII IIIIIIIII�IIIIIIIII I VIIIIIIII VIII IIIIIIIIIIIIII IIIIIIIIIII IIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $. 100.00 <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 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> To[al for this Invoice $ 585.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 585.00 <br /> PAST ®UE <br /> Delinquent charges <br /> Will be forwarded to <br /> COLLECTIONS <br /> 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 I 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%, Penahes,,,yvill be�added att}ye;, �t#,pf 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 />