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SAN JUAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM1 <br /> r Page 1 <br /> 304 E WEBER AVE -3RD FLOOR c —1 <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0001479 <br /> PLEASE MAIL Facility ID F FA0001480 <br /> PERMIT TO b� <br /> BILLING ADDRESS ir�_\��� Date Pnnted 1/26/2007 <br /> �LJ1NS8W4A <br /> RE : USA GASOLINE #110 <br /> USA PETROLEUM CO 2132 MARIPOSA RD <br /> 905 RANCHO CONEJO BLVD STOCKTON, CA 95205 <br /> NEWBURY PARK, CA 91320-1716 <br /> OWNER : USA PETROLEUM CO <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0157227--Date of Invoice: 1/25/2007 IIIIIIIIIIIIIIII VII VIIIIIIIIVIIIVIIIVII VIII VIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 100.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2352 UST FACILITY&1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,265.00 <br /> Payment Due Date 2 <br /> TOTAL DUE this Billing Period $ //l/265-RIO <br /> PAYMENT <br /> RECEIVED <br /> FEB 12 2007 <br /> F" ENVVIIRONMENTALAQUIN TM <br /> HEALTH DEPARTMENT <br /> FEB ` 2 2oo7 <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/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 />