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SAN JUAQUIN GUUN I Y <br /> ENVIRCINMENTAL HEALTH DEPARTME"'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0003419 <br /> Facility ID FA0003831 <br /> Date Printed 1!30/2006 <br /> NORBY, CATHERINE & WILLIAM RE : WATERLOO SHELL" <br /> WATERLOO SHELL* 4315 WATERLOO RD <br /> <br /> <br /> OWNER : NORBY, CATHERINE &WILLIAM <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143390---Date of Invoice: 1127/2006 11111 11111 11111�1111 IN 111111 11111 1111 IN <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 300.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forthis Invoice $ 1,179.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 1,179.00 <br /> PAY , _I JT <br /> RECEIVED <br /> FEB 13 2006 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />