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ENVIRONMENTAL <br /> ENTAL HEALTH DEPARTA T <br /> NVIONMc A Page 1 <br /> 600 EiIAAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0003288 <br /> Facility ID FA0003709 <br /> Date Printed 2/2/2010 <br /> LICENSE& PERMITS RE : VALERO CORNER STORE#3698 <br /> VALERO CORNER STORE#3698 153 E 11TH ST <br /> Pe-B@x-e9ee93 I TRACY, CA 95376 <br /> (,$5 To I" S T OWNER : VALERO CALIFORNIA RETAIL CO <br /> 4AMfbl.0 O-A 3a�a <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0198404—Date of Invoice: 2/2010 11111 11111 11111 11111 IN NII 11111 IN IN <br /> 2/1/2010 2220 M HW G N<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 010 HAZA IAT FEE $ 85.00 <br /> 2/1/2010 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 2/1/2010 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 2/1/2010 2301 UST STAT SURCHARGE FEE $ 15.00 <br /> 2/1/2010 2360 ADDITIONL UST $ 125.00 <br /> 2/1/2010 2360 ADDITION LUST $ 125.00 <br /> 2/1/2010 2362 UST FACT ITY& 1 TANK $ 550.00 <br /> 2/1/2010 2399 I NIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC �LECTRO IC REPORTING SURCHARGE $ 25.00 <br /> Total for this Invoice $ 1,192.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period 1,19 00 <br /> PAYMENT <br /> RECEIVED <br /> 11:17P i c min <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTM_ <br /> HEALTH <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 />