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SAN JUAUtJIN t:UUN I Y <br /> ENVIRONIIAENTAL HEALTH DEPARTMF"T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> PTO e: ON,(209 46 3 202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account AR0004482 <br /> Facility ID FA0002064 <br /> Date Printed IF 1/30/2006 <br /> GASOLINE ACCOUNTING RE : 7 ELEVEN STORE#14117 D/2237' <br /> <br /> <br /> <br /> OWNER : 7- ELEVEN INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143407--Date of Invoice: 1/27/2006 IIIIIIIIIIIIIIVIVIIVIIIVIIVI VI VII VIII IIIIIIIIII IIIIIIIIIIIII <br /> 1/27/2006 2220 SM HVI GEN <5 TONSNR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 270.00 <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 $ 1,149.00 <br /> Payment Due Date /1/20 <br /> TOTAL DUE this Billing Period $ 1,119/00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 7 2006 <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 DES I HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 110% 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 />