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. Mkm 0Vmwully uuu1V1 T <br /> ENVIRONMENTAL HEALTH DEPARTNST Pag 1 <br /> 600 E MAIN STREET • <br /> STOCKTON, CA 95202 ®P <br /> Phone:e: (209(209) 468-3420 <br /> INVOICE \i; AccountlD A�0016814 <br /> Facility ID <br /> FAO 009814 <br /> ci <br /> ci <br /> Date Printed4/28/2011 <br /> >sac� .ac <br /> ACTI RE : ACTI <br /> PO BOX 830 935 E SCOTTS AVE <br /> STOCKTON, CA 95201 STOCKTON, CA 95205 <br /> OWNER : ACTI <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0211694—Date of Invoice: 1/31/2011 IIIIl11III IIIVIIIVIIIVII 1111l1IllIl1I111111111 IIII 11111111111 IN IIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 300.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 30.00 <br /> Total for this Invoicel $ 379.00 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 379.00 <br /> Delinq erif charges <br /> Will be OrWni'fed to <br /> 001.,.,E TO w � <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 /> ,251 rpt <br />