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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr- 'T Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> <br /> 16 <br /> Facility ID I FA0001909 <br /> Date Printed 1/3 /2006 <br /> SATWANT KAUR RE : COUNTRY CLUB FOOD & FUEL MINI MART <br /> COUNTRY CLUB OOD 8r FUEL MINI MART 1856 W COUNTRY CLUB BLVD <br /> 1856 W COUNTRY CLUB BLVD STOCKTON, CA 95204 <br /> STOCKTON, CA 9 204 <br /> OWNER : KAUR, SATWANT <br /> Date Health <br /> L Program Description _ Amount <br /> Invoice# IN0143386---Date of Invoice : 1/27/2006 11111111 IIIM 111 11111 11111 11111�1111 11111 11111 11111 11111 11111 1111 11111�11111 1111 IN <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZVIAT FEE $ 85.00 <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 2360 ADDITION kL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 964.00 <br /> Payment Due Date 3/1/2006 <br /> 1 <br /> TOTAL DUE this Billing Period $ 964.00.=--' <br /> YMEN� CA\ -1k 1 CA 3 <br /> COVNN <br /> - SAN��RONMEN MENT <br /> NSA TN OFPP� <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 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 />