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/�V(V 11• V "I I <br /> ENVIRONMENTAL HEALTH DEPARTMENT • P.yP <br /> $00 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE a Account ID AR0017288 <br /> Facility ID FA0010288 <br /> Date Printed 3/31/2010 <br /> LEMMEMIAMMOMWOMM <br /> MUFFLER MAN (LODI) RE : MUFFLER MAN <br /> <br /> LODI, CA 95240 <br /> OWNER : LOOCK, JIM/LOOCK LIVING TRUST <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0198812--Date of invoice: 2/2/2010 11111IT IppIppIIpI IIpI1111111p11p111ppp111p11pp <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 255.00 <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 $ 25.50 <br /> Total for this Invoice $ 329.50 <br /> -.Payment Due Date 314/2010 <br /> TOTAL DUE this Billing Period $ 329.50 <br /> I SUE <br /> Delinquent C1121"%"S <br /> will k3e iorvva'".i",` t <br /> COfls , k z : <br /> in 3u d6lVs. <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 />