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SAN JUAUUIN L;UUN I Y ENVIRONMENTAL HEALTH DEPARTMF 304 E WEBER AVE - 3RD FLOOR STOCKTON, CA 95202 Phone: (209) 468-3420 INVOICE CALIFORNIA FUEL SUPPLY INC COUNTRY CLUB 76 GAS STATION* 587 YGNACIO VALLEY RD WALNUT CREEK, CA 94596 Page 1 COPY Account tD AR0008426 Facility ID FA0006439 Date Printed 6/22/2006 RE: COUNTRY CLUB 76 GAS STATION* 2575 COUNTRY CLUB BLVD STOCKTON, CA 95204 OWNER: CALIFORNIA FUEL SUPPLY INC Date l Health Program Description Amount Invoice # IN0138576 --- Date of Invoice : 9/28/2005 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII IIIII IIIII III) IIIIII VIII IIII IIII Hrs Employee 9/28/2005 9999 PAYMENT ($ 744.00) 10/3/2005 2303 031 - UST INSTALL PLAN CHECK 4.50 JACKSON $ 418.50 11/7/2005 2303 031 - UST INSTALL PLAN CHECK 1.00 LE $ 93.00 11/17/2005 2303 031 - UST INSTALL PLAN CHECK 1.00 LE $ 93.00 4/27/2006 2303 131 - UST INSTALLATION INSPECTION 5.00 LE $ 465.00 5/31/2006 2303 031 - UST INSTALL PLAN CHECK 1.50 LUCES $ 139.50 6/7/2006 9999 PAYMENT ($ 325.50) Total for this Invoice $ 139.50 Payment Due Date 6/22/2006 TOTAL DUE this Billing Period $ 139.50 PAYMENT RECEIVED JUL 0 6 2006 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 thereafte 5254.rpt