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SAN J,UAQUIN WUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTMr- 'T Page 1 <br /> 3.34 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> <br /> <br /> c <br /> Facility ID FA0003712 <br /> Date Printed 1/30/2006 <br /> . Y <br /> CHEVRON PRODUCTS USA RE : CHEVRON STATION #94275* <br /> CHEVRON STATION #94275* 2905 W BENJAMIN HOLT DR <br /> PO BOX 6004/ L2375-B3 STOCKTON, CA 95207 <br /> SAN RAMON, CA 94583 <br /> OWNER : CHEVRON PRODUCTS USA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143240---Date of Invoice: 1/27/2006 11111 11111 11111 11111 IN 111111 11111 1111 IN <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 390.00 <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 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2350 ADDITIONAL UST-2481 COMPLIANT $ 125.00 <br /> 1/27/2006 2350 ADDITIONAL UST-2481 COMPLIANT $ 125.00 <br /> 1/27/2006 2352 UST FACILITY& 1 TANK-2481 COMPLIANT $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,409.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 1,409.00 <br /> P'AYN I <br /> RE( I1�E� <br /> FEB 1 0 2005 <br /> SAN jCjAQUIN 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 />