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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTreT r 0 <br /> 1868 E HAZELTON AVENUE ' <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 / ,C� <br /> INVOICE Account ID AR0003505 <br /> FaciIityID F FA0001247 <br /> Date Printed 4/4/2013 <br /> BBCN BANK RE : MARCH L 76 - PETROS RAI STATIONS <br /> MARCH LAN ETROS RAI STATIONS 1206 ARCH LN <br /> 3435 WI IRE BLVD STE 700 S CKT5210 <br /> LO NGELES, CA 90010 <br /> OWNER : BB ANK <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0235277---Date of Invoice: 2/1/2013 11111111111111111111 IN 1111 <br /> 2/1/2013 1921 HMBP-Regular-Primary Location $ 360.00 <br /> 2/1/2013 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2013 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 2/1/2013 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 2/1/2013 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 2/1/2013 2360 ADDITIONAL UST $ 125.00 <br /> 2/1/2013 2360 ADDITIONAL UST $ 125.00 <br /> 2/1/2013 2362 UST FACILITY&1 TANK $ 550.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 1,453.00 <br /> Payment Due Date 3/3/2013 <br /> TOTAL DUE this Billing Period $ 1,453.00 <br /> PAYMENTS <br /> RECEIVED <br /> APR 0 4 2013 ///fffgy� <br /> SAN JOAQUIN COUNTY <br /> I2NVIROMENTAL <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 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 /> 5254.rpt <br />