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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEf • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR00042 55 <br /> Facility ID FA0004175 <br /> Date Printed 2/5/2004 <br /> TIKI LAGUN RESORT & MARINA RE : TIKI LAGUN RESORT & MARINA <br /> 834 W FRANCISCO BLVD 12988 W MCDONALD RD <br /> SAN RAFAEL, CA 94901 STOCKTON, CA 95206 <br /> OWNER : HANF, HORST <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0116677---Date of Invoice : 2/4/2004 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 315.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 339.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 339.00 <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 /> 5255.rpt <br />