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SAN JOAQUIN COUNTY Page 1 ENVIRONMENTAL HEALTH DEPARTY "T 304 E WEBER AVE -3RD FLOOR STOCKTON, CA 95202 Phone: (209)468-3420 INVOICE Account ID AR0003362 CORRECTED INVOICE Facility ID FA0002 111 Date Printed 2/7/2005 KENDRICK,JOHN RE : SHELL SERVICE STATION' SHELL SERVICE STATION' 3011 W BENJAMIN HOLT DR 3011 W BENJAMIN HOLT DR STOCKTON, CA 95219 STOCKTON, CA 95219 OWNER : SHELL OIL PRODUCTS US Date Health Program Description Amount Invoice# IN0129015---Date of Invoice: 112412005 I IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 1111111111111 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 1/24/2005 2244 2005 HAZMAT FEE $ 145.00 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 1/24/2005 2360 ADDITIONAL UST $ 125.00 1/24/2005 2360 ADDITIONAL UST $ 125.00 1/24/2005 2362 UST FACILITY& 1 TANK $ 500.00 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 2/15/2005 9997 CORRECTION TO A CHARGE ($ 500.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 125.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 125.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 145.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 15.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 15.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 15.00) 2/15/2005 9997 CORRECTION TO A CHARGE ($ 24.00) Total forthis Invoice $ 200.00 Payment Due Date 2/23/2005 TOTAL DUE this Billing Period $ _ 200.00 PAYMENT RECEIVED FEB 2 3 2005 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 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 thereafter 5255 rpt