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01AI'4')V WUIIv uvuly I r Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMFIJ • <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 �/ <br /> INVOICE `I S AccountID AR0018211 <br /> Facility ID FA0011211 <br /> LMMMMONOMMMMA <br /> Date Printed 4!28/2010 <br /> QUALITY CABINET SHOP RE : QUALITY CABINET SHOPIPORT CITY PLUM <br /> 3256 E TOMAHAWK DR 3256 TOMAHAWK DR <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : QUALITY CABINET SHOP/PORT CITY <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0199050---Date of Invoice: 212/2010 IIIIIIII IIIIII III IIIII IIIII IIIII IIIII IIIIIIIIII IIIII IIIII IIIII IIII IIIIII IIIIIIIIIIIII <br /> 2/112010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/112010 2244 2010 HAZMAT FEE $ 270.00 <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 $ 27.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoicel $ 772.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 772.00 <br /> Delinquent cflarges <br /> will be omiarded to <br /> CO LLE Coff g 0 FM S <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 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 />