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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016079 <br /> FacilityID FA0009079 <br /> Date Printed 3/28/2012 <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# IN0223161 ---Date of Invoice: 1/3012012 1111111111111111111111 IN <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 /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 33.00 <br /> Total for this Invoice $ 625.00 <br /> Payment Due Date 2/29/2012 <br /> TOTAL DUE this Billing Period $ 625.00 <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/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 /> 5254rpt <br />