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SAN <br /> N COUNTY <br /> INTAL HEALTH DEPARTNW J{ f�i4 X01 I 4- 066. Page 1 <br /> ENVIRONMENTAL <br /> 1868 E HAZELTON AVENUE ! F <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE RECEIVED <br /> Account ID FI AR0004482 <br /> I-E <br /> APR 0]. 2014 <br /> Facility ID FA0002064 <br /> ENVIRON —NTAL Date Printed 3/27/2014 <br /> GASOLINE ACCOUNTING RE : 7 ELEVEN STORE#14117 D/2237 <br /> 7 ELEVEN STORE#14117 /2237 2725 COUNTRY CLUB BLVD <br /> <br /> <br /> OWNER : 7-ELEVEN INC <br /> Date Healtn <br /> Program Description Amount <br /> Invoice IN0247485---Date of Invoice: 1/3012014 11111111111111111111 IN IN <br /> 1730/2014 1921 HMBP-Regular-Primary Location $ 285.00 <br /> 1/30/2014 2220 SM HW GEN<5 TONS/VR $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 533.00 <br /> PASTw ^T ^� y Payment Due Date 3/1/2014 <br /> WE WOULD APPRECIATE YOUR TOTAL DUE this Billing Period $ 533.00 <br /> PAYMENT TODAYI <br /> PAYMENT <br /> RECEIVED APPROVED FOR PAYMENT <br /> APR 0 3 2014 <br /> SAw J"O4,U tw couN <br /> , SMEwrA <br /> ,,EALTM <br /> Signature <br /> Date <br /> ENVIRONMENTAL COMPLIANCE <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 HMBP 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 />