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QMMY W^WUMVVVr1II Pagel <br /> ENVIRONMENTAL HEALTH DEPARTM� . <br /> '600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 h <br /> INVOICE 510b 1 Account ID F AR0016839 <br /> Facility ID F FA000 8839 <br /> LWAMMMMMUMMA <br /> Date Printed 4/28/2010 <br /> WEST LANE RADIATOR RE : WEST LANE RADIATOR <br /> 3941 N WEST LN 3941 N WEST LN <br /> STOCKTON, CA 95204 STOCKTON, CA 95204 <br /> OWNER : FORTUNE & FORTUNE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0197910—•Date of Invoice: 2/212010 11111111 111111 III VIII VIII VIII VIII VIII VIII VIII VIII IIIIIIIIIIIII 1111111111111 <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 330.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 211/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9907 Haz Mat Program Penalty Fee $ 33.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for lhls Invoice $ 838.00 <br /> Payment Due Date 3/4/2010 <br /> �,--� TOTAL DUE this Billing Period $ 838.00 <br /> I#� ` L—L <br /> Deiinqu,e:t chargee <br /> t, <br /> Will be twarder; to <br /> COLLS'rnci- a <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 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 />