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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART 4T <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE 1 V Account ID AR0035527 <br /> Facility ID FA0019948 <br /> Date Printed 3/31/2010 <br /> PAYLESS SMOG RE : PAYLESS SMOG <br /> 3227 E MAIN ST A 3227 E MAIN ST A <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : MARIA SERRATO <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0200935—Date of Invoice: 212/2010 11111IN1111111111111111111111111111111111111111IN <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 320/2010 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this lnv oice $ 142.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period 142.50 <br /> b4 `i <br /> Delinquent Charges <br /> Will be forwarded to <br /> OOLLETIO�,pq <br /> 1r ,30, days. <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> [;�at <br /> lties will be added to all Permit Fees For DES I HMMP Fees For all SERVICE FEES <br /> 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 />