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SAN JOAOUIN COUNTY PUBLI�ALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209-468-3420 <br /> INVOIINVOICE AccountlD AR0001456 <br /> CE FA0001457 <br /> Facility ID <br /> Date Printed <br /> 1/31101 <br /> RE : COLLEGEVILLE MARKET & CAFE* <br /> PHILIP MATHEW13521 E MARIPOSA RD <br /> COLLEGEVILLE MARKET&CAFE* STOCKTON CA 95205 <br /> 13521 E MARIPOSA RD <br /> STOCKTON CA 95205 OWNER: LUKOSE,JOSEPH <br /> Health Hrs Employee Amount <br /> Date Program Descripticn <br /> Invoice# IN0079336--Date of invoice: 1130101 <br /> $8.00 <br /> 1130/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE Tank#007 $125.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#006 $500.00 <br /> Underground Storage Tank EH Operating Permit Fee $ <br /> 1/3012001 23fi2 10.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE Total for this Invoice 0 <br /> Payment Due Date 31212001 <br /> TOTAL DUE this Billing Period $651.00 <br /> Please make Checks PAYABLE to: PHS/EHD ! Return a Copy of This STATEMENT with <br /> E FEESPAYMENT <br /> Penalties will be added to all Permit Fees Penalties will be added at the Rate of 10% <br /> at the Rate of J00%of the Base Fee 60 Days after the Invoice Date and each 30 thereafter <br /> 30 Days after the Due Date <br /> PAYMENT <br /> RECEIVED <br /> MAR 0 1 2001 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISIOp: <br /> 5255.rpt ' <br />