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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTR*T • Page <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0001195 <br /> Facility ID FTFA0001196 <br /> Date Printed 1/30/2006 <br /> DARSHAN SINGH MALHI RE : A-1 LIQUOR GAS & FOOD MART <br /> A-1 LIQUOR GAS & FOOD MART 420 W YOSEMITE AVE <br /> 1116 FISHBACK RD MANTECA, CA 95337 <br /> MANTECA, CA 95337 <br /> OWNER : MALHI, DARSHAN SINGH <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142329--Date of Invoice: 1/24/2006 (IIIIIIII VIIIIIIIIIIIVIII VIII VIIVIIIVIIIVII IIIIIIIVIIIIIII <br /> 1/24/2006 1616 RETAIL MARKET< 1000 SO FT W/FOOD PREP $ 160.00 / <br /> n 1 ✓ Total for this Invoice $ 160.00✓ <br /> �1 (h \C�.v..,'-•' V`' Payment Due Date 3/1/2006 <br /> Invoice# IN0143504---Date of Invoice: 1/27/2006 I(IIIIIIIIIIIIIII(IIII(IIII(IIII(IIII(IIII(IIII(IIII(IIII(IIIIIIIIIIIIIIVIIIIIIIIIII <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 85.00 <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 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 $ 964.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 1,124.0 <br /> .. <br /> 01,/ <br /> 1/r,e,JT <br /> FI-8 7 7cr <br /> S ENO"QU/A. <br /> NFA/ 'ROtVr,,F/vAN7), <br /> TIq.7EN4R,.rwEAlr <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 I 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 /> 5254.rpt <br />