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5AN JUAUUIN L;UUN I Y <br /> ENVIlROlvMENTAL HEALTH DEP RTME Page 1 <br /> 304 E WEBER AVE -3RD FLOOR + <br /> STOCKTON, C <br /> <br /> Account ID AR0003458 <br /> WMAMMMEMA <br /> Facility ID FA0003870 <br /> Date Printed 1/26/2007 <br /> MUHAMMAD RIZ AN RE : SRH FOOD & GAS <br /> SRH FOOD & GAS I 749 E CHARTER WAY <br /> 749 E CHARTER 1MAY STOCKTON, CA 95206 <br /> STOCKTON, CA 9 206 <br /> OWNER : RIZWAN, MUHAMMAD <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0157735---Date of Invoice: /25/2007 I(IIIIII IIIIII III VIII VIII VIII VIII VIII IIIII VIII IIIII IIIII IIIII IIII IIIIII VIII 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 $ 85.00 <br /> 1/25/2007 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITION L UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED P ROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,110.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 1,110.0 <br /> >2 <br /> ti F <br /> 4z!_ <br /> 1 �y/�_A,l <br /> \.1 <br /> � 1 <br /> i <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 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 />