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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMof Page 1 304 E WEBER AVE -3RD FLOOR • STOCKTON, CA 95202 Phone: (209) 468-3420 INVOICE Acaounti f F AR0023182 Facility ID FA0013789 Date Printed 11/20/2002 IMOGENE BOWMAN RE : BOWMAN, IMOGENE BOWMAN, IMOGENE 955 WHITE LN 956 N AVALON DR STOCKTON, CA 95215 STOCKTON, CA 95215 OWNER : BOWMAN, IMOGENE Date Health i Program Description Amount Invoice# IN0096965---Date of Invoice: 611412002 6/14/2002 2301 UST STATE SURCHARGE $ 10.00 6/14/2002 2362 UST FACILITY& 1 TANK $ 500.00 6/14/2002 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 6/14/2002 9900 UST TANK FEES $ 500.00 6/14/2002 9900 UST TANK FEES $ 170.00 6/14/2002 9900 UST TANK FEES $ 170.00 6/14/2002 9900 UST TANK FEES $ 170.00 6/14/2002 9900 UST TANK FEES $ 170.00 6/14/2002 9904 UST PENALTIES(TANK) $ 170.00 6/14/2002 9904 UST PENALTIES(TANK) $ 170.00 6/14/2002 9904 UST PENALTIES(TANK) $ 170.00 6/14/2002 9904 UST PENALTIES(TANK) $ 500.00 6/14/2002 9904 UST PENALTIES(TANK) $ 170.00 6/14/2002 9994 PERMIT FEE PENALTY $ 500.00 6/18/2002 9999 PAYMENT PAYMENT ($ 100.00) 7/24/2002 9999 PAYMENT RECEIVE'--) ($ 100.00) 8/7/2002 9999 PAYMENT DEC9/9/2002 9999 PAYMENT D — 9 2002 ($ 100.00) 10/10/2002 9999 PAYMENT ($ 100.00) 11/6/2002 9999 PAYMENT SAN JOAQUIN i. ($ 100.00) PUBLIC HEWN - ENVIHONNIENTAI.Hf/,. Total for this Invoice $ 2,787.50 Payment Due Date 9/29/2002 TOTAL DUE this Billing P 2,7 .50 Pd iaa 6n Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For all SERVICE FEES at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% 30 Days after the Due Da60 Days after t oice Date and each 30 Days thereafter 5255.rpt