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om" %j%jM .(UlN I.VUIV 1 i <br /> ENVIRONMENTAL HEALTH DEPARTME - Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 9 <br /> <br /> <br /> Facility ID FA0001909 <br /> Date Printed 1/26/2007 <br /> SATWANT KAUR RE : COUNTRY CLUB FOOD & FUEL MINI MART <br /> COUNTRY CLUB F OD & FUEL MINI MART 1856 W COUNTRY CLUB BLVD <br /> 1856 W COUNTRY LUB BLVD STOCKTON, CA 95204 <br /> STOCKTON, CA 9 204 <br /> OWNER : KAUR, SATWANT <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0157219---Date of Invoice : 125/2007 11111 11111 IN 111111 11111 IN IN <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR <br /> $ 206.00 <br /> 1/25/2007 2244 2007 HAZN AT FEE <br /> $ 85.00 <br /> 1/25/2007 2301 UST STAT SURCHARGE FEE <br /> $ 15.00 <br /> 1/25/2007 2301 UST STAT SURCHARGE FEE <br /> $ 15.00 <br /> 1/25/2007 2360 ADDITION L UST <br /> $ 125.00 <br /> 1/25/2007 2362 UST FACIL TY& 1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 970.00 <br /> Payment Due Date 2/ <br /> TOTAL DUE t i d $ 970.0 <br /> RECEIVED <br /> FEB 2 6 200T <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 />