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SAN JOAQUIN COUNTY <br /> C"%fli'—:)NMENTAL HEALTH DEPARTT Page 1 <br /> 36 E WEBER AVE -3RD FLOOR 10 is <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0023494 <br /> Facility ID FA0013918 <br /> Date Printed 8/26/2003 <br /> BUSINESS LICENSE & PERMITS RE : CHEVRON STATION #210997 <br /> CHEVRON STATION #210997 1442 COLONY DR <br /> PO BOX 6004 RIPON, CA 95336 <br /> SAN RAMON, CA 94583-0904 <br /> OWNER : CHEVRON STATIONS, INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0110735---Date of Invoice: 8/26/2003 <br /> 8/15/2003 9996 APPLY DISCOUNT ($ 50.00) <br /> 8/26/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> Total for this Invoice $ 150.00 <br /> Payment Due Date 9/25/2003 <br /> TOTAL DUE this Billing Period $ 150.00 <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 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 /> 5255.rpt <br />