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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONN`.ENTAL HEALTH DEPARTN� <br /> 600 L MAIN STREET <br /> 'STOCKTON, CA 95202 C <br /> Q <br /> Pun <br /> Phone:`(209)468-3420 ' <br /> INVOICE ^ , olAR0035834 <br /> ��1 v Facilityto FA0020087 <br /> 6AFs� Ufa YV YVl R 1�l Cr: <br /> P4 A°1�+� ,��r� <br /> \ / Date Printed 3/8/2012 <br /> NNNEENNOMMOMONES <br /> .� VV J <br /> 'h'ufA [� RE : 7-ELEVEN #39208 <br /> 7-ELEVEN #39208 LTE RD <br /> 4M SkLIV& 6LVO- TRACY, CA460 U 95377 <br /> M SirVf OA A53ro4 <br /> I OWNER : BEEBE,J ALLEN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0226332---Date of invoice: 1130/2012 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIVIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 300.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 675.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> Total forthis Invoice $ 1,237.00 <br /> Payment Due Date 2 /2012 <br /> TOTAL DUE this Billing Period $ 1,237.0 <br /> PAYMENT <br /> RECEIVED <br /> MAR 2 2 2012 <br /> SAN JOAQUIN COUNTY <br /> ENVIROMENTAL <br /> HEALTH DEPARTMENT <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 DES I 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 />