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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTr NT Page 1 <br /> 600 E MAIN STREET <br /> ON, 95202 <br /> Phone: 46 COPY <br /> Phone: (209) 468-3420 Q <br /> INVOICE \a 5 \ Account ID 1FAR00i5542 <br /> Facility ID FA0 119963 <br /> Loommomommmmmimi <br /> Date Printed 3/31/2010 <br /> lommmmommammoma <br /> ULLOAS TOW& AUTO REPAIR RE : ULLOAS TOW & AUTO REPAIR <br /> 620 S WILSON WAY STE C 620 S WILSON WAY STE <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : ULLOAS TOW & AUTO REPAIR <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice If IN0200946---Date of Invoice: 2/2/2010 I it ll ll ill l V II VII II I II II II I I III V I VII V II II I IIIIII 1111111111111 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 100,00 <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 $ 10.00 <br /> Total for this Invoicel $ 159.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this�Billing Period $ 159.00 <br /> Delinquem ChargeF <br /> gill be [ervvarded IC <br /> C0LL IRONS, <br /> 4,^. 30 t'Pvq. <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 />