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02/15/2007 11:02 20922 COSTCO 210 <br /> SAN JOAQUIN COUNTY PAGE 02 <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Accwnt l0 IAR0017273 <br /> Facility lD FA0010273 <br /> Date Printed F-1126/2007 <br /> COSTCO WHOLESALE-MEATS#210 RE: COSTCO WHOLESALE-MEATS#210 <br /> <br /> TRACY, CA 96376 <br /> OWNER : COSTCO WHOLESALE CORP <br /> Date Health <br /> Program_ Descdption Amount <br /> Invoice INOISS376—Date of Invoice; 112512007 I�MII��IUdIII�IIIIMII�m��IINIIunIYIIIIIYIIUIIM <br /> 1/25/2007 2214 CalARP FAC STATE SURCHARGE FEE S 270.00 <br /> 1125!2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1125/2007 2244 2007 HAZMAT FEE $ 495.00 <br /> 1/25(2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 996.00 <br /> Payment Due Date 2126/2007 <br /> TOTAL DUE this Billing Period 995.90 <br /> L/ <br /> PAYMENT <br /> REpElVED <br /> -FEB 2007 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <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 OES/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 atter the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />