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-- r W. Ijv VVVIYI r <br /> ENVIRONMENTAL HEALTH DEPARTMF"T Page 1 <br /> 600 E MAIN STREET i <br /> STOCKTON, CA 95202 RECEIVED <br /> Phone: (209) 468-3420 APR 2 0 2009 <br /> INVOICE SAN JOAQUIN COUNTY Account ID AR0016870 <br /> OFFICE OF EMERGENCY SERGE p <br /> Facility ID FA0009870 <br /> Date Printed 3/25/2009 <br /> loommmomommmam <br /> FOREST LAKE GOLF COURSE RE : FOREST LAKE GOLF COURSE <br /> 2450 E WOODSON RD 2450 E WOODSON RD <br /> ACAMPO, CA 95220-9646 ACAMPO, CA 95220 <br /> OWNER : MARGARET J RING <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0185207—Date of Invoice: 1/29/2009 I1111111IIIIIIIII IIIIIIIIII IIIII IIIIIIIIII IIIII IIIIIIIIIIII111IIIIIIII11IIIII IIII IN <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 300.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 30.00 <br /> Total for this Invoice $ 354.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 354.00 <br /> e5 a9T fix$ <br /> )e9irlc:(uent Charges, <br /> w'sl( be forwarded to <br /> COLLET n INNS <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 OES/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 />