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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTNfT • <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> INVOICE <br /> Phone: (209)468-34201 !� <br /> INVOICEV ' /) Account ID AR0035029 <br /> FacilityID FA0019667 a <br /> aye <br /> Dale Printed A4//28/2011 j <br /> PERFORMANCE MACHINE RE : PERFORMANCE MACHINE <br /> 11667 PALM LN UNIT F 11667 PALM LN UNIT <br /> MANTECA, CA 95336 MANTECA, CA 95336 <br /> OWNER : WALT OTT <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0213724---Date of Invoice: 113112011 Iillllll IIIIII III IIIIIIIIII IIIII IIIII IIIII IIIII IIIII IIIA VIII IIII IIIIII VIII IIII IIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 270.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoicel $ 346.00 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 346.00 <br /> Delinquent Changes <br /> will be forwarded to <br /> 11,VLLEC i�P0D 5 <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% 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 />