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SAN JOAQUIN COUNTY • Page 1 ENVIRONMENTAL HEALTH DEPARTOT 304 E WEBER AVE - 3RD FLOOR L STOCKTON, CA 95202 Phone: (209) 468-3420 Account I AR0003402 INVOICE FEB 7 FacilityID FA0003815 Jr Date Printed 1/30/2006 Lonnommmmmommus PLEASE NAIL A. I pZ PERMT TO BILLING AIDDRESS RE : USA GASOLINE #65 2500 W USA GASOLINE #65 905 RANCHO CANEJO BLVD LODI, CAA AVE 9 95240 5 NEWBURY PARK, CA 91320-1716 OWNER : KRISTMONT WEST, INC HealthAmount Date program Description Invoice# IN0142272...Date of Invoice : 1/24/2006 IIIIIIIIIIIIIIII VIIIVIII VIIIVIII VIIIVIIIVIIIVIIIIIIIIIIIV IIIIIIII S`OI Hrs Employee 12/2212005 1615 333-INSPECTION/REINSPECTION 1.00 FLOHRSCHUTZ $ 93.00 (L Total for this lnvolce $ 93.00 Payment Due Date 3/1/2006 Invoice# IN0143211 ---Date of Invoice: 1/27/2006 IIIIIIIIIIIIIIIII 1111 IN $ 200.00 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 100.00 1/27/2006 2244 2006 HAZMAT FEE $ 15.00 1127/2006 2301 UST STATE SURCHARGE FEE $ 15.00 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 1/27/2006 2301 UST STATE SURCHARGE FEE $ 125.00 1/27/2006 2360 ADDITIONAL UST $ 125.00 1/27/2006 2360 ADDITIONAL UST $ 125.00 1/27/2006 2360 ADDITIONAL UST $ 500.00 1/27/2006 2352 UST FACILITY&1 TANK $ 24.00 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE Total for this Invoice $ 1,259.00 Payment Due Date 31" TOTAL DUE this Billing Period $ 1,352. Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For DES/HMMP Fees For all SERVICE FEES 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°/ 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter 5254.rpt