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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 p <br /> C®1 � Account ID AR0043919 <br /> INVOICE <br /> 110111111 <br /> Facility ID FA0023733 <br /> LUMOMMOMMEMA <br /> Date Printed 11/10/2017 <br /> MUNDY, DARSHAN RE : SUNWEST CHEVRON <br /> SUNWEST CHEVRON 2758 W KETTLEMAN LN <br /> 4810 CHILES RD LODI, CA 95242 <br /> DAVIS, CA 95618 <br /> OWNER : TERA INVESTMENTS INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0303131 ---Date of Invoice: 11/1012017 I�IIIIIIIIIIIIAIIIIIIIIIIIIVIVIIVI �IIIIIIIIIII IIIIIIIIIIIII <br /> 11/10/2017 1921 HMBP-Regular-Primary Location $ 313.00 <br /> 11/10/2017 1922 CERS Processing Fee $ 25.00 <br /> 11/10/2017 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 11/10/2017 2301 UST STATE SURCHARGE FEE $ 20.00 <br /> 11/10/2017 2301 UST STATE SURCHARGE FEE $ 20.00 <br /> 11/10/2017 2301 UST STATE SURCHARGE FEE $ 20.00 <br /> 11/10/2017 2350 UST-PER TANK FEE $ 152.00 <br /> 11/10/2017 2350 UST-PER TANK FEE $ 152.00 <br /> 11/10/2017 2350 UST-PER TANK FEE $ 152.00 <br /> 11/10/2017 2351 UST FACILITY-2481 COMPLIANT $ 641.00 <br /> 11/10/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 1,793.00 <br /> Payment Due Date 1211012017 <br /> TOTAL DUE this Billing Period $ 1,793.00 <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 HMBP 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 100/6 <br /> 30 Days after the Due Date 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />