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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016-8 3-9 <br /> LINNOWNEWMEMNA <br /> FacilitylD FA000983 <br /> LMONNOWWWWWWORM <br /> Date Pnnted 1/30/2012 <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, JAMES <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223420•..Date of Invoice: 1/30/2012 II III IIIIIV I II IIIIIIV VI IIII II I I III I II IIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 330.00 <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 /> Total for Is Invoice $ 592.00 <br /> Payment Due Date 2/29/2012 <br /> TOTAL DUE this Billing Period $ 592.00 <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 />