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SAN JUAUU1N C:UUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTM' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> 0\�\A /INVOICE Account ID AR0003180 <br /> n� t� <br /> Facility to FA0003602 <br /> MEM <br /> PLEASE MAIL Date Printed 1/26/2007 <br /> Dl Z PERMITTO <br /> BILLING ADDRESS RE : USA GASOLINE #3502* <br /> USA PETROLEUM CO 35 N CHEROKEE LN <br /> <br /> <br /> OWNER : USA PETROLEUM CO <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN01 57217--Date of Invoice: 1125/2007 IIIIIII IIII VIVIIVI VIIVIIIIIIIIIIIIVIIIVIIVIIIIIIIII VIIIIIII 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 forth is Invoice $ 1,295.00 <br /> Payment Due Date 2/ 007 <br /> TOTAL DUE this Billing Period $ 1,295.00 <br /> RECEIVE �DII;�_` <br /> 200 ft.. FEB - 2 2007 <br /> UM pOUNTY ( L._.— <br /> SAEN'JIRpNMETMENT - <br /> HEpt7N pEPAR <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 DES/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 />