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vrtWvuv 1-v1-13411 Page 1 <br /> IRONMENTAL HEALTH DEPARTME6 <br /> 0 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE �A Account ID AR0016079 <br /> Facility ID FA0009079 <br /> Date Printed F 4/28/2010 <br /> ABC RADIATOR RE : ABC RADIATOR <br /> 601 S WILSON WAY 601 S WILSON WAY <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : EDWARD F FORTUNE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0197641 ---Date ofInvoice: 2/2/2010 1 11111111111111111111 IN 11111111111 IN IIII <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 /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 33.00 <br /> 4/15/2010 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 838.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 838.00 <br /> G SUE <br /> Delinquentchwges <br /> will lae iol-Vt(ardnd 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 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 />