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ENVIRONMENTAL HEALTH DEPARTME"'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 />Page 1 <br />Account ID <br />AR0000719 1 <br />Facility ID <br />FA0000720 <br />Date Printed <br />1/26/2007 <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 <br />Amount <br />Invoice # IN0157520 --- Date of Invoice : 1/25/2007 <br />1/25/2007 <br />2220 <br />SM HW GEN <5 TONS/YR <br />1/25/2007 <br />2244 <br />2007 HAZMAT FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2360 <br />ADDITIONAL UST <br />1/25/2007 <br />2360 <br />ADDITIONAL UST <br />1/25/2007 <br />2362 <br />UST FACILITY & 1 TANK <br />1/25/2007 <br />2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PAYMENT <br />R5MIVED <br />FEB 2 7 20P <br />SM JOAQUIN COUNTY <br />ENVIRONMENTAL <br />jj1LTH DEPARTMENT <br />11111111111111111111 <br />$ <br />IN IN <br />206.00 <br />$ <br />100.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />125.00 <br />$ <br />125.00 <br />$ <br />500.00 <br />$ <br />24.00 <br />Total for this Invoicel $ 1,125.00 <br />Payment Due Date 2/25/2007 <br />TOTAL DUE this Billing Period 1,125.00 <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 thereafte <br />zjy.Ipt <br />