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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMEr <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-342 <br /> count ID AR0000913 <br /> FacilitylD FA0000996 <br /> Date Printed 1/30/2006 <br /> ATTN GASOLINE ACCOUNTING RE : 7 ELEVEN #19976" <br /> 7 ELEVEN #19976" 1399 N MAIN ST <br /> PO BOX 711 MANTECA, CA 95336 <br /> DALLAS, TX 75221-0711 <br /> OWNER : 7- ELEVEN INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142791 --Date of Invoice: 1/2712006 IIII IIIIII III VIII VIII VIII IMI VIIIA VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 270.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,149.00 <br /> Payment Due Date 006 <br /> TOTAL DUE this Billing Period 1,149.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 7 2006 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 /> 5254.rpt <br />