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SAN JOAQUIN COUNTY I Page 1 <br /> ENVIRONMENTAL HEALTH DEP RTM' <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, <br /> <br /> D AR0003348 <br /> Facility ID FA0002541 <br /> Date Printed 1/26/2007 <br /> ATTN GASOLINE CCOUNTING RE : 7 ELEVEN STORE#20632 B/2237 <br /> 7 ELEVEN STORE #20632 B/2237 4627 DA VINCI DR <br /> PO BOX 711 STOCKTON, CA 95207 <br /> DALLAS, TX 75221-0711 <br /> OWNER : 7- ELEVEN INC <br /> Date Health <br /> Proaram Descriptio rlAmount <br /> Invoice# IN0157239---Date of Invoice : /25/2007 I IIIIIII IIIIII III IIID VIII VIII VIII VIII VIII 1111111111 VIII IIIII IIII IIIIII IIIII IIII IIII <br /> 1/25/2007 2220 SM HW G N<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZ AT FEE $ 270.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITION L UST S 125.00 <br /> 1/25/2007 2362 UST FACT ITY& 1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED P OGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,155.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 1,155.0 <br /> PAYMENT <br /> RECEIVED <br /> MAR U 2 �7 <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 />