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JAN JUAWUlrV UUUN I i <br />ENVIRONMENTAL HEALTH DEPARTMF' �� <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />ELIASON, MIKE <br />COUNTRY MARKET CARDLOCK <br />188-A FRANK WEST CIRCLE <br />STOCKTON, CA 95206 <br />Page 1 <br />COPY <br />Account ID AR0011647 <br />Facility ID FA0007491 <br />Date Printed I <br />mx�esa ..� 1/26/2007 <br />RE: COUNTRY MARKET CARDLOCK <br />1524 FRESNO AVE <br />STOCKTON, CA 95206 <br />OWNER: VALLEY PACIFIC PETROLEUM SERV <br />Date Health <br />Program Description Amount <br />Invoice # IN0157250 -- Date of Invoice : 1/25/2007 <br />1/25/2007 <br />2220 <br />SM HW GEN <5 TONS/YR <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <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 />IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII <br />$ <br />IIIIII VIII IIII III <br />206.00 <br />$ <br />15.00 <br />$ <br />500.00 <br />$ <br />24.00 <br />Total for this Invoice $ 745.00 <br />Payment Due Date 2/25/2007 <br />TOTAL DUE this Billing Period $ 45.00 <br />RE/v r <br />�cfl <br />3 FN �qC��/N C <br />yFAi Ty PR�� TY <br />r <br />A <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 />5254 -rpt <br />