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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMEF- <br /> 304 E WEBER AVE -3RD FLOOR .r "/ <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0003362 <br /> Facility ID FA0002111 <br /> Date Printed F 2/5/2004 <br /> KENDRICK, JOHN RE : SHELL SERVICE STA* <br /> SHELL SERVICE STA* 3011 W BENJAMIN HOLT DR <br /> <br /> <br /> OWNER : SHELL OIL PRODUCTS US <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0115578---Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 145.00 <br /> 2/4/2004 2301 UST STATE SURCHARGE $ 15.00 <br /> 2/4/2004 2301 UST STATE SURCHARGE $ 15.00 <br /> 2/4/2004 2301 UST STATE SURCHARGE $ 15.00 <br /> 2/4/2004 2360 ADDITIONAL UST $ 125.00 <br /> 2/4/2004 2360 ADDITIONAL UST $ 125.00 <br /> 2/4/2004 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 1,164.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 1,164.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR 2 9 20P4 <br /> SAN JOAQUIN COLIN.Y <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/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 /> 5255.rpt <br />