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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF"— Page 1 <br /> 304 E WEBER AVE -3RD FLOOR _ <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0013418 <br /> LMMMENNNFAMMA <br /> Facility ID FA0007722 <br /> Date Printed 2/9/2005 <br /> ORLANDO'S#3 RE : ORLANDO'S#3 <br /> PO BOX 1500 18754 E HWY 26 <br /> LINDEN, CA 95236 LINDEN, CA 95236 <br /> OWNER : ORLANDO, SAMUEL BENJAMIN <br /> Date Health <br /> Program Description Amot,nt <br /> Invoice# IN0129963---Date of Invoice: 1/24/2005 11111111111111111111 fill 111111111111 fill 1111 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 115.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2360 ADDITIONAL UST $ 125.00 <br /> 1/24/2005 2360 ADDITIONAL UST $ 125.00 <br /> 1/24/2005 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 934.00 <br /> Payment Due Date 2/23/2005 <br /> Invoice# IN0130589---Date ofInvoice : 2/9/2005 11111111111111111111111111111111111111111111111111111111111111111 <br /> 2/9/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> Total for this Invoice $ 200.00 <br /> Payment Due Date 3/11/2005 <br /> TOTAL DUE this Billing Period $ 1,134.00 <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 /> 25i rpt <br />