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SAN JOAQUIN COUNTY Page 1 <br /> ENV,'RONIAENTAL HEALTH DEP RTi <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 952 <br /> <br /> AR0024977 <br /> Facility ID FA0014678 <br /> Date Printed '',x.•2/7/2005 <br /> ESFANDIARY, FR D RE : MR CAFE <br /> MR CAFE 713 N EL DORADO ST <br /> 5969 SILVEROAK CIR STOCKTON, CA 95202 <br /> STOCKTON, CA 9 219-7187 <br /> OWNER : ESFANDIARY, FRED <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0130230---Date of Invoice: Ih/24/2005 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 85.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STAKE SURCHARGE $ 15.00 <br /> 1/24/2005 2360 ADDITIONAL UST $ 125.00 <br /> 1/24/2005 2360 ADDITION L UST $ 125.00 <br /> 1/24/2005 2362 UST FACT ITY&1 TANK $ 500.00 <br /> 1/24/2005 2399 UNIFIED FROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 904.00 <br /> Payment Due Date 2/23/2005 <br /> Invoice# IN0130539---Date of Invoice: 7/2005 I IIIIIII IIIIII III IIID(IIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 2/7/2005 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> Total for this Invoice $ 200.00 <br /> Payment Due Date 3/9/2005 <br /> TOTAL DUE this Billing Period $ 1,104.00 <br /> Please make Checks PA ABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees I 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 /> 5255.rpt <br />