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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTM' 304 E WEBER AVE - 3RD FLOOR STOCKTON, CA 95202 Phone: (209) 468-3420 INVOICE LOVES COUNTRY STORE Page 1 Account ID AR0020960 Facility ID 1/27/2006 FA0012659 Date Printed 3/9/2006 RE: LOVES COUNTRY STORE 1553 COLONY RD RIPON, CA 95366 OWNER: LOVES COUNTRY STORES OF CA Date Health Program Description Amount Invoice # IN0143415 --- Date of Invoice: 1/27/2006 1/27/2006 2220 SM HW GEN <5 TONS/YR 1/27/2006 2244 2006 HAZMAT FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2360 ADDITIONAL UST 1/27/2006 2360 ADDITIONAL UST 1/27/2006 2360 ADDITIONAL UST 1/27/2006 2360 ADDITIONAL UST 1/27/2006 2362 UST FACILITY & 1 TANK 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII $ IIIIII VIII IIII IIII 200.00 $ 285.00 $ 15.00 $ 15.00 $ 15.00 $ 15.00 $ 15.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 500.00 $ 24.00 Total for this Invoice $ 1,584.00 Payment Due Date / 0 6 $ 1,584.0 TOTAL DUE this Billing Period SAN JUl�O'JIP: C(}UNT+' TAEEN\,IRONMEIT4t( HEAETN DER ,, M Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For OES / HMMP Fees For all SERVICE FEES 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% 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafte 5254.rpt