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I <br /> SANLJOAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMO • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccounuD AR0001864 <br /> Facility lD 7FA0001858 <br /> Date Printed 2/5/200=. <br /> MY MINI MART RE : MY MINI MART <br /> 1756 N WILSON WAY 1756 N WILSON WAY <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : LAL, JOGINDER <br /> Date Health Ama:nt <br /> Program Description <br /> Invoice# IN0116375--Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR S 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 85.00 <br /> 2/4/2004 2301 UST STATE SURCHARGE S 15.00 <br /> 2/4/2004 2301 UST STATE SURCHARGE $ 15D0 <br /> 2/4/2004 2360 ADDITIONAL UST S 125.`' <br /> 2/4/2004 2362 UST FACILITY& 1 TANK S 500.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24�'-'O <br /> Total for this Invoice $ 964-DO <br /> Payment Due Date 3/61204 <br /> TOTAL DUE this Billing Period $ 964.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 3 zoo, <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> "FALTH 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 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 /> 5255.`pt <br />