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JAIV JUAUUIN L.UUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMIK t <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003402 <br /> Facility ID FA0003815 <br /> a\\ PLEASE MAIL Date Printed 1/26/2007 <br /> PERMIT TO <br /> vl✓' BILLING ADDRESS RE : USA GASOLINE#65 <br /> USA GASOLINE#65 2500 W LODI AVE <br /> 905 RANCHO CANEJO BLVD LODI, CA 95240 <br /> NEWBURY PARK, CA 91320-1716 <br /> OWNER : KRISTMONT WEST, INC <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0157050---Date of Invoice: 1/25/2007 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIilllllllllllllllllllllllllll IIIIIIII <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 100.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST 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 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 /> Total for this Invoice $ 1,265.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 1,265.00 <br /> R�E V Ep <br /> FEg 12 2001 <br /> SAN JOAOUIME�PNS <br /> -__.,� ENTHDEPARTMENT <br /> FEB <br /> / <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 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 />