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ENVIRONMENTAL HEALTH DEPARTMI <br /> 304 E VVEBER AVE -3RD FLOOR Page 1 <br /> STOCKTON, CA 95202 INEW <br /> Phone: (209) 468-3420 COPY <br /> INVOICE Account to I AR0003501 <br /> IMENINNINMENINNINNE <br /> Facility ID FA0003911 <br /> Date Printed 1/30/2006 <br /> TOM VAN DE POL RE : VAN DE POL ENTERPRISES INC <br /> VAN DE POL ENTERPRISES 816 E FRONTAGE RD <br /> PO BOX 1107 RIPON, CA 95366 <br /> STOCKTON, CA 95201 <br /> OWNER : VAN DE POL ENTERPRISES <br /> Date Health <br /> _ -- Program Description <br /> 7= <br /> mount <br /> IN0143350—Date of Invoice: 1/27/2006 IIIIIIIIIIIIIiIII VIII VIIIVIIIIIIIIIIIIIIIIIIVIII ILIIIIIIIIIIIIIIIIIIIIII VIII IIII IIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <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 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY 8 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,019.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period 1,019.00 <br /> Rcq yMFit <br /> FAlryOn g9TN-47Y <br /> MF,I,T <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 /> i?i4 lit <br />