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SAN JOAQUIN COUNTY i• .91 7 A <br />ENVIRONMENTAL `r°EALTH DEPAR, <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />THREE PALMS GROCERY <br />6732 E WATERLOO RD <br />STOCKTON, CA 95215 <br />Page 1 <br />Account .tfl AR0003669 <br />Facility ID FA0004030 <br />Date Printed 2/27/2003 <br />RE: THREE PALMS GROCERY <br />6732 E WATERLOO <br />STOCKTON, CA 95215 <br />OWNER: BOZZANO, LINO <br />Health <br />v Date Program Description — Amount <br />Invoice # IN0104595 -- Date of Invoice: 2/27/2003 <br />2/27/2003 <br />2244 <br />2003 HMMP Annual Fee <br />$ 85.00 <br />2/27/2003 <br />2301 <br />UST STATE SURCHARGE <br />$ 10.00 <br />2/27/2003 <br />2301 <br />UST STATE SURCHARGE <br />$ 10.00 <br />2/27/2003 <br />2360 <br />ADDITIONAL UST <br />$ 125.00 <br />2/27/2003 <br />2362 <br />UST FACILITY & 1 TANK <br />$ 500.00 <br />2/27/2003 <br />2399 <br />UNIFIED PROGRAM FAC STATE SERVICE FEE <br />$ 17.50 <br />Total for this Invoicel <br />$ 747.50 <br />Payment Due Date <br />3/29/2003 <br />TOTAL DUE this Billing Period <br />$ 747.50 <br />PAYMENT <br />RECEIVED <br />MCR :5 2083 <br />PUBLIC HEALTH SEii'0CE <br />EWIRONMENTAL HEALTH DI'V!SION <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 Days thereafter <br />5255.rpt <br />