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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0004255 <br /> Facility ID FA0004175 <br /> Date Printed /30/2014 <br /> TIKI LAGUN PARTNERS LLC RE : TIKI LAGUN RESORT& MARINA <br /> TIKI LAGUN RESORT& MARINA 12988 W MCDONALD RD <br /> 3620 W HAMMER LN SUITE D STOCKTON, CA 95206 <br /> STOCKTON, CA 95219 OWNER: TIKI LAGUN PARTNERS LLC <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0247470---Date of Invoice: 1130/2014 <br /> 1/30/2014 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 113012014 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAG STATE SURCHARGE FEE $ 35.00 <br /> 1/30/2014 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 675.00 <br /> Total for t $ 1,238.00 <br /> Payment Due Date 3/1/2014 <br /> TOTAL DUE this Billing Period $ 1,238.00 <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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> S254.rpt <br />