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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMPage 1 <br /> Iff <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0036181 <br /> MMENNNNNEMENOMM <br /> Facility ID FA0020264 <br /> Date Printed 4/28/2011 <br /> RAMIREZ, JAIME RE : RAMIREZ AUTO BODY <br /> RAMIREZ AUTO BODY 516 E WORTH <br /> 902 S STANISLAUS ST STOCKTON, CA 95206 <br /> STOCKTON, CA 95206 <br /> OWNER : RAMIREZ,JAIME <br /> Date Health <br /> Program Description Amount <br /> Invoice# ING213966---Date of Invoice: 1/31/2011 11111111111111111111 IN IN <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 4/15/2011 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoicel $ 475.00 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 475.00 <br /> PAST DO UD° <br /> INE WOULD APPRECIATE YOUR <br /> PAYMENT TODAY! <br /> (�}Ui' I-lEpLTh PERIai i t 0h <br /> TFSE OupRENT.-YEAR- . <br /> WILL NOT BE ISSUED UN T ii- <br /> PASDUE <br /> FULL oT <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 />