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SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTM• Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0035029 <br /> LMNOMMUMMMOMMM <br /> Facility ID FA0019667 <br /> Date Printed 3/28/2012 <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 III III� 'III IIIA VIII VIII VIII VIII VIII VIII VIII IIIIIIIIIIIIIIIIIII IN <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 270.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice $ 346.00 <br /> Payment Due Date 2/29/2012 <br /> TOTAL DUE this Billing Period $ 346.00 <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/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 />