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SAN JUAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr­ 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountID AR0013418 <br /> Facility ID I FA0007722 <br /> Data Printed F 1/30/2006 <br /> SHAW,SANJIB RE : ORLANDO'S <br /> ORLANDO'S 18754 E HWY 26 <br /> 31 MEADOWS CT LINDEN, CA 95236 <br /> FREMONT, CA 94539 <br /> OWNER : SHAW, SANJIB <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0144657—Date of Invoice: 1/27/2006 IIIIIIIIIIIVIIVI VIIIIIIIIIVIIIVIIIVIII VIIIVIIIIII IIIIIVIIIIIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <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 2350 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 Invoice $ 1,019.00 <br /> Payment Due Date411.20006TOTAL DUE this Billing Period <br /> PAYNIEINIT <br /> RECEIVED <br /> 4198 - 1 2006 <br /> 9AN4Q>tQQItI QOUNT" -- — <br /> ENVIRONMENTAL <br /> HEALTH DEPA.RTMENf <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 after the Invoice Date and each 30 Days thereafter <br /> i254 rpt <br />