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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART)WdaPage 1 <br /> §04 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0018053 <br /> Facility ID FA0011053 <br /> LMMMENOMMMMA <br /> Date Printed F 2/25/2005 <br /> IMMMMEMMMEMOMA <br /> CHAMPION RE : CHAMPION <br /> 1301 N EUCLID AVE 1220 VANDERBILT CIR <br /> PRINCETON, IL 61356 MANTECA, CA 95336 <br /> OWNER : GARDNER DENVER INC <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0128436---Date of Invoice: 1/24/2005 1111111111111111111111111 IN 111111111111111 IN <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 315.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 2q 0 <br /> Total for this Invoice $ 539.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $ 539.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 8 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 /> 5255.rpt <br />