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SAN,JUAUUIN CUUN1Y Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> r, <br /> INVOICE Account lD AR0035542 <br /> Facility ID FA0019963 <br /> Date Printed F 4/28/2011 <br /> lommummmmsmomom <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 /> Health <br /> Dale program Description Amount <br /> Invoice# IN0213850---Date of Invoice: 1/31/2011 IIIIIIII VIIIA VIII VIIVIIIVIIIIII VIIILIIIIIIIIII VIII IN IN <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 100.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> Total forthis Invoice $ 159.00 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 159.00 <br /> T1 ti, - <br /> 'Delinquent Charg{eae <br /> J31� fl)rtiEFr�f irA`p�Se4 o <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 />