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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART—NT <br /> 600 E MAIN STREET <br /> STOCKTON, CA <br /> <br /> unt ID AR0016997 <br /> Facility ID FA0009997 <br /> Date Printed 2/2/201 <br /> COUNTRY CLUB SERVICE RE : COUNTRY CLUB SERVICE <br /> 1403 W COUNTRY CLUB BLVD 1403 W COUNTRY CLUB BLVD <br /> STOCKTON, CA 9204 STOCKTON, CA 95204 <br /> OWNER : GRIFFEN, STEPHEN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0197957---Date of Invoice: 2/2/2010 I111I1I11III11IIIVlII VIII VIII ILII VIII VIII VIII VIII Iglu VIII 111111111111111 <br /> IIII IIII <br /> 2/1/2010 2228 GEN 25<50 TONS PERMIT n$ 1,911.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 145.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONICREPORTING SURCHARGE $ 25.00 <br /> Total for this Invoice $ 2,105.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 2,105.0 <br /> ' PAYMENT <br /> RECEfVED <br /> I MAR 0 8 2010 <br /> SAN JOAQUIN COUNTY <br /> EW RON MENTAL <br /> HEALTH DEPARTMENT <br /> t <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 /> �2i4.rpt <br />