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SAN JOAQUIN COUNTY _ <br /> ENVIRONMENTAL HEALTH DEPARTP T Page 1 <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID r AR0003361 <br /> Facility ID FA0002324 <br /> Date Printed 1/28/2008 <br /> MARIGOLD SHELL* RE : MARIGOLD SHELL* <br /> 6131 PACIFIC AVE 6131 PACIFIC AVE <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> OWNER : TRAIN, HUNG THANH <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0170915---Date of Invoice : 1/25/2008 1111E III$E 111 111�11111 11111 11M 11111 11111 11111 11111 11111�111 11111 1111�1111 1111 <br /> 1/25/2008 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 85.00 <br /> 1/25/2008 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2008 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2008 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2008 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2008 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2008 2362 UST FACILITY& 1 TANK $ 550.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,167.00 <br /> Payment Due Date 2/27/2008 <br /> TOTAL DUE this Billing Period $ 1,167.00 <br /> PAYME' � <br /> RECFI\"`-l_ <br /> FEB 2 i <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 />