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JMIY JVM�+(VIIV VVVIY I 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF-'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> <br /> Account ID AR0003458 <br /> Facility ID _FA 00LMEMMM <br /> 03870 <br /> Date Printed 1/30/2006 <br /> MUHAMMAD RIZ AN RE : SRH FOOD & GAS <br /> SRH FOOD & GAS 749 E CHARTER WAY <br /> 749 E CHARTER WAY STOCKTON, CA 95206 <br /> STOCKTON, CA 95206 <br /> OWNER : RIZWAN, MUHAMMAD <br /> Date Health <br /> Program Descriptior Amount <br /> Invoice# I N0143916--Date of Invoice: /27/2006 11111111111111 h 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 1111 111111 11111 1111 1111 <br /> 1/27/2006 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZ AT FEE $ 85.00 <br /> 1/27/2006 2301 UST STAT 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 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITION L UST $ 125.00 <br /> 1/27/2006 2362 UST FACIL TY& 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forthis Invoice $ 1,104.00 <br /> Payment Due Date 5/1/2b06 <br /> TOTAL DUE this Billing Period $ 1,104.00 <br /> RECD V�V)- <br /> ED <br /> FEB <br /> 2 2 2006 <br /> SAN jOAQUI <br /> NC <br /> HEgLTH J&PM,-rq <br /> T <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 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 /> 5254.rpt <br />