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'*SAN JOAQUIN COUNTY PUBALTH SERVICES Page 1 <br /> ` ENVIRONMENTAL HEALTH ON <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0003421 <br /> FAO003833 <br /> Facility ID <br /> Date Printed 2/16/01 <br /> RE : SUPER STORE INDUSTRIES* <br /> SUPER STORE INDUSTRIES 16888 S MCKINLEY AVE <br /> <br /> OWNER : SUPER STORE INDUSTRIES <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0079473---Date of Invoice: 1/30/01 <br /> 1/30/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#002 $125.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#003 $125.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#004 $125.00 <br /> 1/30/2001 2362 Underground Storage Tank EH Operating Permit Fee Tank#001 $500.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $1,017.00 <br /> Payment Due Date 3 1 <br /> TOTAL DUE this Billing Period 1,017.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEE <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMENT <br /> RECEIVED <br /> FEB 16 2001 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5255.rpt <br />