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r * SAN JOAOUIN COUNTY PUBLIC ALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON. CA 95202 <br />209468-3420 <br />INVOICE <br />COUNTRY CLUB SHELL <br />COUNTRY CLUB SHELL* <br />2575 COUNTRY CLUB BLVD <br />STOCKTON CA 95204 <br />Page 1 <br />Account ID AR0008426 <br />FA0006439 <br />Facility ID <br />Date Printed 1/31/01 <br />RE: COUNTRY CLUB SHELL* <br />2575 COUNTRY CLUB BLVD <br />STOCKTON CA 95204 <br />OWNER: EQUILON LLC ENTERPRISES <br />He-1th <br />Date Program Description Hrs Employee Amount <br />Invoice # IN0079545 --- Date of Invoice : 1/30101 <br />1/30/2001 2220 <br />1130/2001 2301 <br />1/30/2001 2301 <br />1,130/2001 2301 <br />1/3012001 2360 <br />1/30/2001 2360 <br />1/3012001 2362 <br />1/30/2001 2399 <br />5255.rpt <br />SM HW GEN <5 TONS/YR <br />$100.00 <br />UST STATE SURCHARGE <br />$8.00 <br />UST STATE SURCHARGE <br />$8.00 <br />UST STATE SURCHARGE <br />$8.00 <br />Underground Storage Tank EH Operating Permit Fee Tank # 007 <br />$125.00 <br />Underground Storage Tank EH Operating Permit Fee Tank # 008 <br />$125.00 <br />Underground Storage Tank EH Operating Permit Fee Tank # 005 <br />$500.00 <br />UNIFIED PROGRAM FAC STATE SERVICE FEE <br />$10.00 <br />Please make Checks PAYABLE to: PHS/EHD / <br />Total for this Invoice $884.00 <br />Payment Due Date A$8 <br />01 <br />TOTAL DUE this Billing Period 00 <br />Return a Copy of This STATEMENT with Your PAYMENT <br />Penalties will be added to all Permit Fees For all SERVICE FEES <br />at the Rate of 100% of the Base Fee Penalties will be added at the Rate of 10% <br />30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br />RECINLED <br />FEB 2 3 2001 <br />