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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTM#T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0004645 <br /> Facility ID FA0002463 <br /> Date Printed 1/2 412 0 0 5 <br /> IMOMMMMENOMMInd <br /> FOOD 4 LESS RE : FOOD 4 LESS <br /> 8014 LOWER SACRAMENTO RD#1 678 N WILSON WAY <br /> STOCKTON, CA 95210 STOCKTON, CA 95205 <br /> OWNER : PAQ INC <br /> Date Health <br /> Program Description v Amount <br /> Invoice# IN0128648--Date of Invoice: 1/24/2005 IIIIIIIIIVIIIVIIVIIVIIIVIIVIIVIIIVIIVIIIIIIIIIIIIIIIIIIIIIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 85.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2360 ADDITIONAL UST $ 125.00 <br /> 1/24/2005 2362 UST FACILITY 8 1 TANK $ 500.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 2400- <br /> Tot <br /> 400To[al for lois Invoice $ 964.00 <br /> Payment Due Date 5 <br /> TOTAL DUE this Billing Period $ 964.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 14 2405 <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 DES I 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 /> 525irpt <br />