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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR ' <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003117 <br /> ,RM110 FAR; <br /> Facility ID I FA0003539 <br /> Date Printed 1/26/2007 <br /> BIRLA, SANJAY RE : S B GAS & MARKET <br /> S B GAS & MARKT 515 W 11TH ST STE 301 <br /> PO BOX 55277 TRACY, CA 95376 <br /> HAYWARD, CA 9 545 <br /> OWNER : BIRLA, SANJAY <br /> Date Health <br /> Program Descriptio i Amount <br /> Invoice# IN0157251 ---Date of Invoice: 1/25/2007 11111 11111 HE 11111 11111 1111 11111 1111 111111 11111 1111 1111 <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZ AT FEE $ 100.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 !UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACT ITY&1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,125.00 <br /> PAYMENT Payment Due Date 2/25/2007 <br /> RECEIVED <br /> TOTAL DUE this Billing Period $ 1,125.00 <br /> FEB 2 6 200 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> I <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 />