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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT r Page 1 1868 E HAZELTON AVENUE STOCKTON, CA 95205 _ ' Phone: (209) 468-3420 I -7o7 — 39 rj ~7 f Account ID F AR0027871 INVOICE Facility ID FA0015977 Date Printed 11/30/2017 FAST LANE CENTRAL VALLEY RE : FAST LANE CENTRAL VALLEY CHRISTINA GILL 116 ROTH RD OWNER : FAST LANE CENTRAL VALLEY LLC Date Health Program Description Amount Invoice# IN0299067---Date ofInvoice: 9/2612017 111111111111111111111111 IN 9/26/2017 1921 HMBP-Regular-Primary Location $ 313.00 9/26/2017 1922 CERS Processing Fee $ 25.00 9/26/2017 2220 SM HW GEN<5 TONS/YR $ 249.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2350 UST-PER TANK FEE $ 152.00 9/26/2017 2350 UST-PER TANK FEE $ 152.00 9/26/2017 2350 UST-PER TANK FEE $ 152.00 9/26/2017 2350 UST-PER TANK FEE $ 152.00 9/26/2017 2350 UST-PER TANK FEE $ 152.00 9/26/2017 2351 UST FACILITY-2481 COMPLIANT $ 641.00 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 Total for this Invoice $ 2,137.00 p Payment Due Date 10/2912017 F'/'A' ST DUE.i TOTAL DUE this Billing Period $ 2,137.00 WE WOULD APPRECIATE YOJR FAti.1—N i'TODAY! 2 � I Please make Checks P ABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT It will be added to all Permit Fees For HMBP Fees For all SERVICE FEES at the Rate of 100%of the Base Fee enalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% 30 Days after the Due Date 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter 5254.rpt