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U7/1//2UU7 14:1J1 2V94b4V1J8 LNVINUNNLNIAL HLALIH PAUL Ul/UZ <br /> ;AN JOAQUIN COUNTY Page 1 <br /> NVIR�INMENTAL HEALTH DEPARTME.,, <br /> ;00 E MAIN STREET <br /> WOCKTON, CA 95202 <br /> >horfe: (209)468-3420 J J <br /> INVOICE <br /> Q ° 'J I �Ip AR0003169 <br /> Famliy ID r FAD003591 <br /> 512712009 <br /> JIMS 24 HOUR GAS N GO' VE® <br /> HARRINGTON,JAMES A r , 8203 E HWY 28 SEP 17 2009 <br /> JIMS 24 HOUR GASE4 GO' /V 0 I STOCKTON, CA 96215-9536 <br /> 4111 CLARINBRIDGE CIR <br /> DUBLIN,CA 94668N JOAQUIN COUNTY <br /> Q IJ6 / OWNER : JAMES MICHAEL&ASSO FEMERGENCYSERVICES <br /> 11111, IN <br /> Date tbRh 2� un <br /> Progn1m Description <br /> Invoice a IN018YAS--Date of invoice: 1129200Y A��� ��.�■�� <br /> 1/292009 2220 SM HW GEN<5 TONS/YR 213.00 <br /> 1/29/2009 2201 HA FEE / S 100.00 <br /> 1/29/2009 2301 UST STATETE 15.00 <br /> SURCHARGE FEE S <br /> UST <br /> 1/29/2009 2301 UST STATE SURCHARGE FEE t 15,00 <br /> 1292009 2301 UST STATE SURCHARGE FEE S 1500 <br /> 125.00 <br /> 1/292009 2360 ADDITIONAL UST S <br /> 1/292009 2360 ADDITIONAL UST S 125.00 <br /> 1/292009 2382 UST FACILITY& 1 TANK S 550.00 <br /> 1292009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE10. <br /> FEE S 100 <br /> 3/152009 9967 Haz Mat Pro9mm Penalty Fite $ 0.00 <br /> 4 &2009 9994 PERMIT FEE PENALTY S 213,00 <br /> 11 <br /> 4/15/2009 9994 PERMIT FEE PENALTY S 550.00 <br /> 41151'2009 9994 PERMIT FEE PENALTY $ 125.00 <br /> 41152009 9994 PERMIT FEE PENALTY St $ 125.00 <br /> ✓ TOW for thl hvol = 2,205-00 <br /> 1 / PAST DUE <br /> lJ TOTAL DUE this Billing Perlotl S 2,205.00 <br /> `i` U1��� <br /> Delinque c ges <br /> GI will be 1 a d to <br /> C ECT/CA <br /> in 30 dabs. <br /> Please rtmke Chocks PAYABLE to: 'EHEY - Return a Copy of This STATEMENT with Your PAYMENT <br /> Panaltles will be added to a0 Parnin Fees For OEES/HUMP Fees For all SERVICE FEES <br /> al 010 Rab of 100%of the Base Fee ParaMtiae wM be added at the Ram of 10% Penaltbs will be added at the Rate of 10% <br /> 30 Days after the Due Dare 4S Days agar the Invoice Date &D Days after the Invoice Data and each 30 Days tnlreatl <br /> 5254.rpt <br />