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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME - Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTOIN, CA 9520 <br /> <br /> Account ID AR0010247 III <br /> 111 <br /> Facility ID FA0007080 <br /> Date Printed 13/1/2004 <br /> u®® <br /> QB REBUILDER RE : QB REBUILDER <br /> 2325 W CHARTER WAY 2325 W CHARTER WAY <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER : QUICK BRAKE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0115428---Date of Invoice : 2/4/2004 <br /> 2/4/2004 2229 GEN 50<250 TONS PERMIT $ 2,016.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 450.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> 2/15/2004 9997 CORRECTION TO A CHARGE ($ 2,016.00) <br /> 2/20/2004 2248 RCRA GEN 25<50 TONS $ 1,792.00 <br /> Total for this Invoice $ 2,266.00 <br /> Payment Due Date 304 <br /> TOTAL DUE this Billing Period $ 2,266.00 <br /> 1 <br /> PAYMEN-1 <br /> RECEIVED <br /> LIAR 1 � 2F"r <br /> SAN JOACIUIN 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 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 /> 5255.rpt <br />