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Page 1 <br /> SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMW s .. <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 AR0003673 <br /> INVOICE Account ID <br /> Facility ID FA0004033 <br /> Date Printed 1/24/2005 <br /> <br /> <br /> <br /> <br /> OWNER : TOSCO NORTHWEST CO <br /> Health <br /> Amount <br /> ,_,,.—_ <br /> Date Program Description <br /> Invoice# IN0128725—Date of Invoice: 112412005 11111111 IIIIIIIII VIII VIII IIIIIIIIII VIII VIII VIII VIII VIII VIII/III 111111 VIII IIIIIIII <br /> $ 200.00 <br /> 112412005 2220 SM HW GEN<5 TONS/YR $ 285.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 15.00'' <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00'' <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1124/2005 2301 UST STATE SURCHARGE $ 125.00 <br /> 1/2412005 2360 ADDITIONAL UST $ 125.00' <br /> 1/24/2005 2360 ADDITIONAL UST $ 500.00 <br /> 1/24/2005 2362 UST FACILITY 8 1 TANK $ 24.00' <br /> 112412005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br /> Total for this lnvoica $ 1,304.00 <br /> Payment Due Date 212312005 <br /> TOTAL DUE this Billing Period 0,304.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 3 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENT AL <br /> HEALTH DEPARTMENT <br /> Please make Checks PAYABLE to: 'EHD' – Return a Copy of This STATEMENT with Your PAYMENT <br /> For DES 1 HMMP Fees For all SERVICE FEES <br /> Penalties will be added to all Permit Fees Penalties will be added at the Rate of 10% <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% 60 Das after the Invoice Date and each 30 Days thereafter <br /> 30 Days after the Due Date 45 Days after the Invoice Date Y <br /> 2555rpt <br />