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JAN JUAUUIN UUUN I T <br /> ENVIRONMENTAL HEALTH DEPARTMF"T Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003314 <br /> Facility ID 7FAOO03735 <br /> Date Printed 1/30/2006 <br /> QUICK STOP MART RE : QUICK STOP MART* <br /> 2057 S ELDORADO ST 2057 S EL DORADO ST <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER : SINGH, SUKHINDER/DHILLON, C <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0144310---Date of Invoice: 1/27/2006 11111 1111 111111 11111 1111 IN <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 Date3/1/200 <br /> TOTAL DUE this Billing Period $ 64.00 <br /> Coj�lvco <br /> FEB 13 ?ovh <br /> S yRo V ;,OUN7y <br /> N�t7 y pFp n , <br /> NT <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 OES/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 />