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SAN JOAQUIN COUNTY r'y� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 500 E MAIN STREETCOPY <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 Lo <br /> Account ID AR0035521 <br /> INVOICE J <br /> Facility ID FA0019948 <br /> Date Printed 4/28/2011 <br /> PAYLESS SMOG RE : PAYLESS SMOG <br /> 3227 E MAIN STA 3227 E MAIN ST A <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : MARIA SERRATO <br /> Health Amount <br /> Date Program Description <br /> Invoice# IN0213840---Date of Invoice: 1/31/2011 IIIIIIII IIII�IIII�IIII IIIIIIII�IIII�II�III II�II'IIIIIIIII�IIII III�IIIIII VIII��IIIIII <br /> $ 85.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 24.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 25.00 <br /> 1/28/2011 _ ERSC ELECTRONIC REPORTING SURCHARGE $ 8.50 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee <br /> Total for this Invoice $ 142.50 <br /> Payment Due Date 3/212011 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> 1 � . T -a <br /> Delinquent charge <br /> will be orvvai"ded to <br /> COYLE 99 sb"v Op <br /> ir 30 Ja.vs. <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 OES 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%, 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 />