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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR000s,os <br /> Facility ID FA0006423 <br /> Date Printed 2/2/2015 <br /> GALVAN, JULIO RE : UNITED GAS <br /> UNITED GAS 3440 E MAIN ST <br /> 3440 E MAIN ST STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 <br /> OWNER : GALVAN, JULIO <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0258148--Date of invoice: 11/19/2014 1IIII VIII II II VI I IIIIIIIIIVIIIVII 11111 EIIIIIII11111011111110II111111 <br /> 11/19/2014 1615 RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PREP) S 03.00 <br /> Total for this Invoice $ 2 Op <br /> ?t L � of5Payment Due Date 0 <br /> Invoice# IN0260704--Date of invoice: 1/2912015 IIIII1IIIilllilllllllllllllllVIII1I1III1III1I1I1IIIIIIII111111111111111111111111111111111 <br /> 1/29/2015 1920 HMBP-Common Materials $ 85.0 <br /> 1/29/2015 2220 SM HW GEN <5 TONS/YR $ 213 <br /> 1/29/2015 2301 UST STATE SURCHARGE FEE $ 15 0"' <br /> 1/29/2015 2301 UST STATE SURCHARGE FEE $ 1 .00� <br /> 1/29/2015 2301 UST STATE SURCHARGE FEE N Q� $ 5.00 <br /> 1/29/2015 2360 ADDITIONAL UST V.1'iv�_)IA�./) $ 30.00 <br /> 1/29/2015 2360 ADDITIONAL UST <br /> 1/29/2015 2362 UST FACILITY 8 1 TANK $ µ7j 550.00` <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FE $ 35.00 <br /> Q To I for this Invoice $ 1,188.00' <br /> %r /t Due Date 2/28/2015 <br /> TOTAL DUE this Billing Period /$ 1,391.00 <br /> + <br /> J"7ti 1 a.bvc L- �L�t -7 0 5� <br /> Ips( Gam. z9, 2-0 <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Yoor PAYMENT <br /> Penalties will be added to all Permit Fees For HMBP 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 />