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JAN JUAWUIN t, UUN I T <br /> ENVIRONMENTAL HEALTH DEPARTME`' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0007862 <br /> Facility ID FA0004345 <br /> Date Printed 1/26/2007 <br /> JAHANT FOOD N FUEL STOP RE : JAHANT FOOD N FUEL STOP <br /> PO BOX 2735 24323 N HWY 99 <br /> LODI, CA 95241 ACAMPO, CA 95220 <br /> OWNER : SINGH, BACHITAR <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0157185—Date of Invoice: 1/25/2007 I(IIIIII IIIIII III IIIII IIIII IIIII VIII IIIII IIIII IIIII IIIII VIII IIIII(III IIIIII VIII IIIIIIII <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 100.00 <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 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 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 $ 1,265.00 <br /> Payment Due Date 2! 2 7 <br /> TOTAL DUE this Billing Period $ 1,265.00 <br /> PAYMENT' <br /> RECEIVED <br /> FEB 0 9 200;' <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />