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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTNW • Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0001864 <br /> Facility ID FA0001858 <br /> Date Printed 1/30/2006 <br /> LAL, JOGINDER RE : MY MINI MART <br /> MY MINI MART 1756 N WILSON WAY <br /> 1756 N WILSON WAY STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 <br /> OWNER : LAL,JOGINDER <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice IN0143368---Date of Invoice: 1/27/2006 11111 IN 1111111111111111111 <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 85.00 <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 $ 964.00 <br /> Payment Due Date 3l1/70Q6 <br /> TOTAL DUE this Billing Period $ /964.00\l1 <br /> RECEI•. ,-D <br /> MAR - i 2006 <br /> SAN JOAOUIPI COUNT( <br /> ENVIRONMENTAL <br /> HEALTH DEPA.RTMEN'r <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 />