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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003451 <br /> Facility ID FA0003863 <br /> Date Printed 1/26/2007 <br /> DOMINGUEZ, MICHAEL RE : FREMONT SHELL* <br /> FREMONT SHELL* 2494 E FREMONT ST <br /> 2494 E FREMONT ST STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 <br /> OWNER : DOMINGUEZ, MICHAEL <br /> Date Health <br /> Program Description _ _ Amount <br /> Invoice# IN0156931 --Date of Invoice : 1/25/2007 11111 1111 111111 11111 IN IN <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 130.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2350 ADDITIONAL UST-2481 COMPLIANT $ 125.00 <br /> 1/25/2007 2352 UST FACILITY& 1 TANK-2481 COMPLIANT $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,015.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period 1,015.00 <br /> 60 <br /> F V D <br /> FEB 2 3 2007 <br /> SAN JOAQUIN COUNN <br /> HEALTH T <br /> DEPARTMEN <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 OES/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 /> 5254.rpt <br />