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SAN JOAQUIN COUNTY 1 ' <br /> ENVIRONMENTAL HEALTH DEPARTST Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> 'Phone: (209)468-3420 <br /> INVOICE Account ID AR000asss <br /> Facility ID FA 0002590 <br /> Date Printed F 1/30/2012 <br /> RAI GAS STATIONS INC RE : THORNTON 76 <br /> THORNTON 76 8606 THORNTON RD <br /> <br /> <br /> OWNER : <br /> RAI <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0224173---Date of Invoice: 1/30/2012 1111111111111111111111111111111 IN 111111 Hill 11111111 <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 285.00 <br /> 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2012 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2012 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2012 2362 UST FACILITY&1 TANK $ 550.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> vTotal for this Involca f 1,392.00 <br /> Payment Due Date 2/29/2 <br /> \ TOTAL DUE this Billing Period $ 1,392.00 <br /> PAYHIEN'� <br /> )�v �e RECENEO <br /> FEB 0 g 2012 <br /> )� ���..��iiDHIME1rTAL <br /> . c:e TH nEPARTU� <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 />