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JAN JUAWUIN L;UUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTMI- Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> / INVOICE Account ID AR0003443 <br /> V Facility ID FA0003855 <br /> Date Printed 1/26/2007 <br /> &V)1 � PLEASE MAIL <br /> ���/// 1 A PERMIT TO RE : USA GASOLINE#3696* <br /> BILLING ADDRESS <br /> USA PETROLEUM 2448 W KETTLEMAN LN <br /> 905 RANCHO CONEJO BLVD LODI, CA 95240 <br /> NEWBURY PARK, CA 91320-1716 <br /> OWNER : USA PETROLEUM CO <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0157233---Date of Invoice: 1/25/2007 I IIIIIII IIIIII III VIII(IIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 270.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,295.00 <br /> Payment Due Date 2/ 7 <br /> TOTAL DUE this Billing Period $ 1,295.00 <br /> pAYMENT <br /> RECEIVED <br /> r p _ FEB 12 2001 <br /> SAN JOAOUIN COUNTAL <br /> TY <br /> ^-1HEALTH DEPARTMENT <br /> �, ; FEB - 2 2007 <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 />