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SAN ,IOAr.1UIN COUNTY • Page 1 <br /> ENVIRONMENTAL HEALTH DEPAR10.NT <br /> 304 E WEBER AVE -3RD FLOOR <br /> i� <br /> STOCKTON, CA 95202 j <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0001864 <br /> Facility ID FA0001858 <br /> Date Printed F 2/27/2003 <br /> -�7 <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 Amount <br /> Program Description <br /> Invoice# IN0104205—Date of Invoice: 2/2712003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 85.00 <br /> 2/27/2003 2301 UST STATE SURCHARGE $ 10.00 <br /> 2/27/2003 2301 UST STATE SURCHARGE $ 10.00 \1 <br /> 2/27/2003 2360 ADDITIONAL UST $ 125.00 51 <br /> 2/27/2003 2362 UST FACILITY 8 1 TANK $ 500.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this Invoice $ 947.50 <br /> Payment Due Date 312912003\ <br /> PAYMENT TOTAL DUE this Billing Period $ 947.50 <br /> RECEIVED <br /> MAR 5 2003 <br /> PAN JAOUIN COUNTY <br /> UBLIC HEEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <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 all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10 <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 Daysthereafter <br /> 5255.rpt <br />