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')HIV JUAWUIIV %,.UUIV I T <br /> ENViftNMENTAL HEALTH DEPARTMFtJT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 917 <br /> INVOICE AccountlD AR0023494 <br /> CFacility ID FA0013918 <br /> Date Printed 1 1/30/2006 <br /> BUSINESS LICENSE & PERMITS RE : CHEVRON STATION #210997' <br /> CHEVRON STATION #210997* 1442 COLONY DR <br /> PO BOX 6004/1-2375-133 RIPON, CA 95336 <br /> SAN RAMON, CA 94583-0904 <br /> OWNER : CHEVRON STATIONS, INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0144445---Date of Invoice: 1/27/2006 11111 11111 IN IIIIII 11111 1111 1111 <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR <br /> $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE <br /> $ 270.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE <br /> $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE <br /> $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST <br /> $ 125.00 <br /> 1/27/2006 2362 UST FACILITY& 1 TANK <br /> $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice 1 $ 1,149.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 1,149. <br /> PA E dot' <br /> RECFI1✓ C7 <br /> FEB 1 0 ZGi <br /> SAN JOAQUI�,`NOUN"i y <br /> ENVIRONMENTAL <br /> HEALTH DEPARTIbIENT <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 OES/HMMP 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 /> 5254.rpt <br />