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5AN JIJAQUIN L;UUN I Y <br /> ENVIRONMENTAL HEALTH DEP RTM- 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0007834 <br /> Facility ID FA0006388 <br /> Date Printed 1/30/2006 <br /> PATEL, MAHESH RE : KWIK SERVE <br /> KWIK SERVE 950 W 11TH ST <br /> 950 W 11TH ST TRACY, CA 95376 <br /> TRACY, CA 95376 <br /> OWNER : PATEL, MAHESH <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0144091 ---Date of Invoice: 1/27/2006 11111 11111 1111 111111 11111 IN IN <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZ AT FEE $ 100.00 <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 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACT ITY& 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for thislnvoice $ 1,119.00 <br /> Payment Due Date 3/ <br /> TOTAL DUE this Billing Period $ 1,119.00 <br /> �r <br /> 0 <br /> `'oti jj <br /> 91GGr. <br /> y0 /V <br /> R1'464- <br /> Please <br /> TM6TPlease 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 />