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JAN JUAWUIN UUUN I T ENVIRONMENTAL HEALTH DEPARTMF "r , 304 E WEBER AVE - 3RD FLOOR STOCKTON, CA 95202 Phone: (209) 468-3420 INVOICE LUTZ, ROBERT & KATHY SHELL FOOD MART* 2320 N EL DORADO ST STOCKTON, CA 95204 Page 1 COPY Account ID AR0008445 Facility ID FA0006447 Date Printed 1/30/2006 RE: SHELL FOOD MART* 2320 N EL DORADO ST STOCKTON, CA 95204 OWNER: LUTZ, ROBERT & KATHY Date Health Program Description Amount Invoice # IN0143392 --- Date of Invoice : 1/27/2006 1/27/2006 2220 SM HW GEN <5 TONS/YR 1/27/2006 2244 2006 HAZMAT FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2301 UST STATE SURCHARGE FEE 1/27/2006 2360 ADDITIONAL UST 1/27/2006 2360 ADDITIONAL UST 1/27/2006 2362 UST FACILITY & 1 TANK 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE 1111111111111111111111 IIE IIIII VIII IIID VIII VIII VIII VIII VIII IIII $ IIIIII IIIII IIII IIII 200.00 $ 270.00 $ 15.00 $ 15.00 $ 15.00 $ 125.00 $ 125.00 $ 500.00 $ 24.00 Total for this Invoice $ 1,289.00 Payment Due Date 3 2006 TOTAL DUE this Billing Period $ ,289 0 PA �D �gNFEB 21 lQ��, ENvGR QUTA, -p HEACT y D P9gTENT Please make Checks PAYABLE to: 'EHD' -- Return a Copy of This STATEMENT with Your PAYMENT 'enalties will be added to all Permit Fees For CIES / HMMP Fees For all SERVICE FEES 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% 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafte 5254.rpt