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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF7"T Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID I AR0003204 <br /> Facility ID FA0003626� <br /> Date Printed 4/2/2008 <br /> KHA Q VO RE : OAK PARK GAS & CONVENIENCE STORE <br /> OAK PARK GAS & CONVENIENCE STORE 3212 N CALIFORNIA ST <br /> 3212 N CALIFORNIA ST STOCKTON, CA 95204 <br /> STOCKTON, CA 95204 <br /> OWNER : VO, KHA Q <br /> Date Health <br /> Program Description Amount i <br /> Invoice# IN0174877---Date of Invoice : 4/2/2008 1111111 111111 111 11111 11h 11111 11111 11111 IIE 11111 11111 11111 1111 11111�11111 IN IN <br /> 4/2/2008 2220 SM HW GEN <5 TONS/YR $ 213.00 <br /> 4/2/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 237.00 <br /> Payment Due Date 5/2/2008 <br /> TOTAL DUE this Billing Period $ 237.00 <br /> P ECE vED <br /> R <br /> APR 2 9 2p08 <br /> COU14V <br /> SP ENS koN' RTMENT <br /> HFpUTN OePA <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 /> 5154 rpt <br />