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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTQN AVZNUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0029646 <br /> Facility ID FA0016764 <br /> Date Pnnted 1/29/2015 <br /> IAN KOETSIER RE : IAN KOETSIER <br /> 21447 S MANTECA RD 21447 S MANTECA RD <br /> MANTECA, CA 95337 MANTECA, CA 95337 <br /> OWNER : IAN KOETSIER <br /> Date Health <br /> Program Description Amount i <br /> Invoice# IN0262200---Date of Invoice: 1/29/2015 IIIIIIIIIIIIIVIIVIIVIIVIIVIIVIIVIIIIIIIIIIIIIIIIIIIIVIII IIIIIIII <br /> 1/29/2015 1958 HM-Farm Operations $ 18.00 <br /> 1/29/2015 2221 USED OIL ONLY-<5 TONS/YR $ 54.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 107.00 <br /> Payment Due Date 2/2812015 <br /> TOTAL DUE this Billing Period $ 107.00 <br /> 0 <br /> D <br /> FEB 1 V015 <br /> ENVIR <br /> Ito, +{ <br /> pER. <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 HMBP 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.rp1 <br />