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SAN JOAQUIN COUNTY <br /> ENMONMENTAL HEALTH DEPA TMF- T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003288 <br /> Facility ID FA0003709 <br /> Date Printed 1/30/2006 <br /> LICENSE & PERMI S RE : VALERO #3698 <br /> VALERO#3698 153 E 11TH ST <br /> PO BOX 690007 TRACY, CA 95376 <br /> SAN ANTONIO, TX 78269-0007 <br /> OWNER : ULTRAMAR INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143403---Date of I voice: 1,27/2006 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 1/27/2006 2220 S HW GE <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2 06 HAZM AT 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 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITION''I�IL 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 $ 1,104.00 <br /> Payment Due Date 3 6 <br /> TOTAL DUE this Billing Period $ ,104.0 <br /> FEB Z .1 2006 <br /> SAN JOAQUIP:COUNT`( <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />