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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPAR' :NT ti Page 1 <br /> 304 E WEBER AVE •3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR000 3362 <br /> Facility ID FA0002111 <br /> Date Printed F 4/28/2003 <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 I <br /> Invoice# IN0103374—Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 145.00 <br /> 2/27/2003 2301 UST STATE SURCHARGE $ 10.00 <br /> 2/27/2003 2301 UST STATE SURCHARGE $ 10.00 <br /> 2/27/2003 2301 UST STATE SURCHARGE $ 10.00 <br /> 2/27/2003 2360 ADDITIONAL UST $ 125.00 <br /> 2/27/2003 2360 ADDITIONAL UST $ 125.00 <br /> 2/27/2003 2362 UST FACILITY&1 TANK $ 500.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> 4/15/2003 9987 Haz Mal Program Penalty Fee $ 14.50 <br /> 4/28/2003 9999 PAYMENT ($ 1,142.50) <br /> Tot al for this lnvolce $ 14.50 <br /> Payment Due Date �3129/2�003 <br /> % At (y TOTAL DUE this Billing Period $ 14.50 <br /> PAYMENT <br /> RECEIVED <br /> MAY - 8 2003 <br /> SAN JOAOUIN COUNTY <br /> PUBLIC HEALTH SERVICES , <br /> ENVIRONMENTAL HEALTH DIIISION <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 /> 5255.mt <br />