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600 E MAIN STREET . • <br /> .STOCKTON, CA 95202 <br /> Phone: (209)468-3420 \ <br /> RECEIVED COPY <br /> INVOICE <br /> Account ID AR0016839 <br /> v]JL 3 f 4i'l <br /> Facility ID FA0009839 <br /> SAN JOAQUIN COUNTY <br /> OFFICE OF EMERGENCY SERVICE <br /> ate Footed 5/26/2011 <br /> —111 <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# IN0210931 ...Date of Invoice: 1/3112011 1111111111 IN IIIIIIIII 111111111111111111 <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 330.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/20/2011 9987 Haz Mal Program Penalty Fee $ 33.00 <br /> 4/15/2011 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 838.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 838.00 <br /> ., A ST LJUM' <br /> Delinquent charges <br /> will be Toniia ded to <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 />