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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0045648 <br /> INVOICE <br /> Facility ID FA0024461 <br /> Date Printed 1/30/2020 <br /> VILLASENOR, HELI JR RE : SMOG TECH TRACY <br /> HELI VILLASENOR JR 24588 S MACARTHUR DR <br /> 24588 S MACARTHUR DR TRACY, CA 95376 <br /> TRACY, CA 95376 <br /> OWNER: HELI VILLLASENOR JR <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0330045--Date of Invoice: 9/26/2019 11111 11111 1111 111111 EII IN IN <br /> 9/26/2019 1920 HMBP-Common Materials $ 115.00 <br /> 9/26/2019 1922 CERS Processing Fee Jy) $ 30.00 <br /> 9/26/2019 2220 SM HW GEN<5 TONS/YR $ 249.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> 12/15/2019 9987 Haz Mat Program Penalty Fee 11.50 <br /> 12/15/2019 9994 PERMIT FEE PENALTY $ 249.00 <br /> �otalfor this Invoice $ 703.50 <br /> PAST DUE <br /> bNE����L D A�PPRE-'IAT E YOUR TOTAL DUE this Billing Period $ 703.50 <br /> PAY;jF-N, TODAY! <br /> Delinquent charges <br /> will be forwarded to <br /> in 30 days. <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 HMBP 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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />