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ENVIRONMENTAL HEALTH DEPARTMW • Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 nn <br /> INVOICE Account ID AR0035029 <br /> RECEIVED <br /> Facility ID F FA0019667 <br /> JUL 3 0 2009 Date Printed F 7/28/2009 <br /> SAN JJOA�QgUIINN C�OUSN�TYg�ICEg <br /> PERFORMANCE MACHINE RET'AW9 ME 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 <br /> Program Description Amount <br /> Invoice# IN0189673—Date of Invoice: 5/26/2009 111111111111II III IIIII IIIII IIIII IIIII IIIII IIIIIIIIII IIIIIIIIII IIII111111IIIII IIII IIIA <br /> 5/26/2009 2244 2009 HAZMAT FEE PLUS 2 YEARS BACK BILLING $ 810.00 <br /> 5/26/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 7/15/2009 9987 Haz Mat Program Penalty Fee $ 81.00 <br /> Total for this Invoice $ 915.00 <br /> Payment Due Date 6/26/2009 <br /> TOTAL DUE this Billing Periodl $ 915.00 <br /> y UUM <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 OES/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 ml <br />