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SAN JOAQUIN COUNTY Page 1 <br /> ENVIF.ONit`nENTAL HEALTH DEPARTM- 'T <br /> 304 E WEBER AVE -3RD FLOOR <br /> PTO 95202 COPY <br /> Phone:e: (209(209)46 468-3420 <br /> INVOICE Account ID AR0 00 0-18-4 <br /> Facility ID FA0000 8-5 <br /> Date Printed 1/30/2006 <br /> B ANDERSON, LICENSES/PERMITS RE : CIRCLE K STORE#1205* <br /> CIRCLE K STORE#1205* 16470 CAMBRIDGE ST <br /> 495 E RINCON ST STE 150 LATHROP, CA 95330 <br /> CORONA, CA 92879 <br /> OWNER : CIRCLE K STORES INC <br /> Date Health <br /> Pmgram Description Amount <br /> Invoice# IN0143643—Date of Invoice: 112712006 IIIIIIIIIIIIVIVIIIIIIIIIIVII IIIIIIIIIIVIII VIIIVIII IIIIIIIIII IIIIIIIII IIII <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 270.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,149.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 1,1 .0 <br /> PA <br /> REL6,6 D <br /> FEB 13 <br /> SAN�OgQU zou� <br /> /N <br /> N H D ZP'AN k <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/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 atter the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254slit <br />