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• SAN JOAQUIN COUNTY PUBLIC HEA T.TH SERVICES ENVIRONMENTAL HEALTH DIVISI 304 E WEBER AVE - 3RD FLOOR STOCKTON, CA 95202 209-468-3420 INVOICE COUNTRY CLUB SHELL RE: COUNTRY CLUB SHELL* 2575 COUNTRY CLUB BLVD STOCKTON CA 95204 OWNER: Page 1 Account IDI AR0008426 Facility ID FA0006439 Date Printed 4/24/00 COUNTRY CLUB SHELL* 2575 COUNTRY CLUB BLVD STOCKTON CA 95204 EQUILON LLC ENTERPRISES Health Date Program Description Hrs Employee Amount Invoice # IN0069748 --- Date of Invoice : 4/19/00 4/19/2000 2220 SM HW GEN <5 TONSNR 4/19/2000 2301 UST STATE SURCHARGE 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE 5255.rpt Please make Checks PAYABLE to : PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For all SERVICE FEES at the Rate of 100%ofthe Base Fee Penalties will be added at the Rate of 10% 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter RAY IENT F7! P'_-CEVVEI JUN 8 2000 �, ,. JUAQUIN COON rY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION $100.00 $24.00 Tank # 005 $170.00 Tank # 007 $170.00 Tank # 008 $170.00 $10.00 Total for this Invoice $644.00 Payment Due Date 5/2412 TOTAL DUE this Billing Period $644.00 Please make Checks PAYABLE to : PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For all SERVICE FEES at the Rate of 100%ofthe Base Fee Penalties will be added at the Rate of 10% 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter RAY IENT F7! P'_-CEVVEI JUN 8 2000 �, ,. JUAQUIN COON rY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION