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SAN JAQUIN COUNTY PUBLIC HEALTH SERVICES Report #5255 <br /> 4NVIANMENTAL HEALTH DIVIS N Sta' ent Printed : 02/05/96 <br /> 3046 WEBER AVENUE — 3RD F`rr'OR *4e/ <br /> p0 BOX 388 <br /> STJCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> J rauc�- .1. c: c—r <br /> TO : SHELL OIL COMPANY INC -- <br /> <br /> <br /> ATTN : HS&E ADMIN SUPPORT Facility ID 002111 <br /> RE : BENJAMIN HOLT SHELL <br /> 3011 W BENJAMIN HOLT DR STOCKTON <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> Service Activity <br /> Date Description Hrs Employee Amount <br /> Invoice 9 026268 -- Date of Invoice: 02/05/96 <br /> 02/05/96 2301 UST State Surcharge Fee Tank # TA188305 $56 . 00 <br /> 02/05/96 2301 UST State Surcharge Fee Tank # TA188304 $56 . 00 <br /> 02/05/96 2301 UST State Surcharge Fee Tank # TA188302 $56 . 00 <br /> 02/05/96 2301 UST State Surcharge Fee Tank # TA188301 $56 . 00 <br /> ------------------------------------- <br /> Total for this invoice : $224 . 00 <br /> Payment DUE DATE 03/06/96 <br /> If this INVOICE has been Paid, Please Disregard this Notice . . . <br /> PAYMEN I <br /> RFCIr-111'-TA <br /> FEB 2 31996 <br /> 3AIV JOAUi,,!, �;; ;,_. <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMITS at the rate of 11E of the Service Fee <br /> at the rate of 100% of the Base Fee 31 days after the Payment DUE DATE <br /> 31 days after the Payment DUE DATE. and EACH 31 days thereafter. <br /> TOTAL DUE this Billing Period : $224 .00 <br /> Account 1-30 Days 31-60 Days 61-90 Days 91-120 Days 121+ Plus <br /> Summary <br /> 904 . 00 0 . 00 0 . 00 897 . 00 0 . 00 <br /> L/ 010, <br />