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SAN'JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0035029 <br /> LMMMMMMMMOMM <br /> Facility ID F 00 119667 <br /> Date Printed F 1/30/2012 <br /> LEMEMMOMEMMENO <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 <br /> Program Description Amount <br /> Invoice# IN0226132---Date of Invoice: 1130/2012 (IIII III VIVA LIVI VIIIV IVIIIVII VII II II 1111111111111 <br /> 1127/2012 2244 2012 HAZMAT FEE $ 270.00 <br /> 1127/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1127/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> Total for this Invoice $ 319.00 <br /> Payment Due Date 2129/2012 <br /> TOTAL DUE this Billing Period $ 319.00 <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 />