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JAN JUAI.IUIN t:UUN I Y <br /> ENVIRONMENTAL HEALTH DEPART i Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 �(J <br /> Phone: (209)468-3420 <br /> INVOICE AccountlDAR0003410 <br /> \�10� Facility ID FA0002048 <br /> PLEASE MAIL Date Printed F 1/26/2007 <br /> PERMIT TO <br /> BILLING ADDRESS <br /> USA GASOLINE#835 E : USA GASOLINE#835 <br /> <br /> STOCKTON, CA 95204 <br /> OWNER : USA PETROLEUM CO <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0157226---Date of Invoice: 1125/2007 IIIIIIIIIIIVIIVIIIVIVIIIVIIIIIVIIVIIVIIIVIIIIIIII VIIIIIIIIIII <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 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 $ 1,125.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 125.00 <br /> REENEn <br /> FES 12 2001 <br /> SA E30 ONMEOT' L <br /> AL <br /> _ HE 4\11 OEFPRTMENT <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 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 />