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SAN JUAI.lUIN CUUN I Y Page 1 <br /> ENVROWMENTAL HEALTH DEPARTME# • <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE 1 a 1 Account ID AR0028329 <br /> Facility ID F FA0016206 <br /> Date Printed 3/31/2010 <br /> POLYBAU PRIMA PRODUCTS RE : POLYBAU PRIMA PRODUCTS <br /> 23314 CABOT BLVD 1851 PARADISE RD A <br /> HAYWARD, CA 94545-1685 TRACY, CA 95304 <br /> OWNER : PRIMA PRODUCTS INC DBA POLYBAU <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0199496---Date of Invoice : 2/2/2010 IIIIIIII VIVIIIVIIIVIVIII VIIVIIVI VIIIA IIIIVIIIIIIIII <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this Invoice —$---142.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> Deli nqu ni charges <br /> Will L-v forvrarc ("d, is <br /> in 30 days. <br /> Please make Checks PAYABLE to: -El - 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 />