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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> INVOICE Account ID AR0016291 <br /> Facility ID FA0009291 <br /> Dale Printed 4/30/2012 <br /> TEDS WELDING& REPAIR RE : TEDS WELDING&REPAIR <br /> PO BOX 726 8932 E HWY 12 <br /> VICTOR, CA 95253 VICTOR, CA 95253 <br /> OWNER : G WILLIAM BRAUN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223246---Date of Invoice: 1/30/2012 IIIIIIIIIIIIII VIII VIIVIIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 285.00 <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 $ 28.50 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 788.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 788.50 <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 />