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"•vtKUNMENTAL HEALTH DEPARTME <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 Page 1 <br /> Phone: (209) 468-3420 "Vol <br /> INVOICE COPY <br /> Account ID AR0003501 <br /> Facility ID r FA0003911 <br /> Date Printed 1/26/2007 <br /> TOM VAN DE POL <br /> VAN DE POL ENTERPRISES RE : VAN DE POL ENTERPRISES INC <br /> PO BOX 1107 816 E FRONTAGE RD <br /> STOCKTON, CA 95201 RIPON, CA 95366 <br /> OWNER : VAN DE POL ENTERPRISES <br /> Date Health <br /> Program Description <br /> — — Amount <br /> Invoice# IN0157154--Date ofInvoice: 1/2512007 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIVIIIVIIIVIIIVIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 206.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 U $ 15.00ST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Totalfor this Invoice $ 1,025.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 1,025.00 <br /> PA`MAE-T <br /> RECE <br /> FEB 13 2oor <br /> COUNTY <br /> SANJOAOUIEINVIV, MFNTAL <br /> HEALTH OFPApTMFNT <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 />