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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTML�.r ... <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0001479 <br /> Facility ID FA000 4480 <br /> PLEASE MAIL Date Printed 1/30/2006 <br /> PERMIT TO <br /> C• �� I.F-2, BILLING ADDRESS <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 /> Health <br /> Date Fiograrri Description Amount <br /> Invoice# IN0143394---Date of Invoice : 1/27/2006 IIIIIIIIIIIIIIIIIVIIIVIIIVIIIIIIiIVIIIVII VIIIVIIIVIIIIIIILIIIIiVIIIILIILII <br /> 27/20 SM H $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 100.00 <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 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 2360 ADDITIONAL UST $ 125.00 <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 lnvolce $ 1,259.00 <br /> ^1 Payment Due Date 3/1/2006 <br /> 0 I I 1 TOTAL DUE this Billing Period5259.�OVL/!� <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 /> ansa mi <br />