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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTmNT — Page 1 <br /> M <br /> 304E WEBER AVE -3RD FLOOR RECEIVED JAN 72005 <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0017824 <br /> Facility ID F FA0010824 <br /> Date Printed F 112 4 12 0 0 5 <br /> VINTAGE PETROLEUM INC RE : VINTAGE PETROLEUM INC <br /> PO BOX 609 12350 S CROCKER RD <br /> RIO VISTA,CA 94571-1230 STOCKTON, CA 95206 <br /> OWNER : VINTAGE PETROLEUM INC <br /> Date Health <br /> Program Description p p Amount <br /> Invoice# IN0128603--Date ofInvoice: 112412005 <br /> IIIIIIIIIIIIIIIIIIIIIIII� IIINVIIIVIIVIIIIIIUIIIIIIIIIIIIIIIIIIII <br /> 124/2005 2220 SM HW GEN 45 TONS/YR S 200.00 <br /> 1242005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 21232005 <br /> TOTAL DUE this Billing Period $ 224.00 <br /> Vendor: AFE #: <br /> Entity Name' _ <br /> Entity #: A/190 -3 (1 <br /> Major At: 5100 _Minor #: 1027 <br /> Subcadit#: 2711 AFE At <br /> bescrlption: Annual Permit to Operate 015 <br /> Level 1 Approval: Datc: ,-� 1 L, <br /> � <br /> Level 2 Approval: _ T. — PAYMENT <br /> RECEIVED <br /> FEB 1 4 NL-� <br /> SAN ENVIRONMENTAL <br /> OAQUIN NTAL <br /> ENVIRONMENTAL <br /> OUNTY <br /> "Dub f.�.- 1 HEALTH DEPARTMENT <br /> t <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 DES I 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 Dale 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> t2-;Ht <br />