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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTN 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0003361 <br /> Facility ID FA0002324 <br /> u.� <br /> Date Printed 1/26/2007 <br /> MARIGOLD SHELL* RE : MARIGOLD SHELL* <br /> 6131 PACIFIC AVE 6131 PACIFIC AVE <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> OWNER : TRAN, HUNG THANH <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0157293---Date of Invoice: 1/25/2007 11111 11111 11111 11111 HE IIIII IIIII IN 111111 11111 1111 IN <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 85.00 <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 Invoicel $ 1,110.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 1,110.00 <br /> ECE VES <br /> r, 0 a 20U i <br /> oto <br /> SAN QCOUNTY <br /> NMENTAL <br /> NV <br /> tjEALTH 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 />