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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMr'- T <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />MADSEN'S SUNRISE DAIRY <br />239 S STOCKTON ST <br />RIPON, CA 95366 <br />I. Page 1 <br />Account ID <br />�AR0000719 <br />Facility ID <br />FA0000720 <br />Date Printed <br />1/30/2006 <br />RE: MADSEN'S SUNRISE DAIRY <br />239 S STOCKTON ST <br />RIPON, CA 95366 <br />OWNER: MADSEN, ROBERT & CAROL <br />Date Health <br />Program Description Amount <br />Invoice # IN0143692 --- Date of Invoice : 1/27/2006 <br />1/27/2006 <br />2220 <br />SM HW GEN <5 TONS/YR <br />1/27/2006 <br />2244 <br />2006 HAZMAT FEE <br />1/27/2006 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/27/2006 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/27/2006 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/27/2006 <br />2360 <br />ADDITIONAL UST <br />1/27/2006 <br />2360 <br />ADDITIONAL UST <br />1/27/2006 <br />2362 <br />UST FACILITY & 1 TANK <br />1/27/2006 <br />2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />1111111 I1IIIIIII VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII 111111 VIII IIII IIII <br />$ 200.00 <br />$ 100.00 <br />$ 15.00 <br />$ 15.00 <br />$ 15.00 <br />$ 125.00 <br />$ 125.00 <br />$ 500.00 <br />$ 24.00 <br />Total for this Invoice $ 1,119.00 <br />Payment Due Date 3/ <br />TOTAL DUE this Billing Period $ 1," 19.0 i <br />"AR 13 20o6 <br />SAN JOAQUTA, Cir\'i Y <br />ENVIROn/MEIJTAL <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 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 />