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i -T Page 1 _..uC —A 95205 (209) 468-3420 Account ID AR0004351 INVOICE Facility ID FA0000556 w b Date Printed 3/16/2018 4, RANDHAWA, DIDAR SINGH RE : CHEROKEE LANE SERVICE STATION* CHEROKEE LANE SERVICE STATION* 900 S CHEROKEE LN 900 S CHEROKEE LN LODI, CA 95240 LODI, CA 95240 OWNER : DIDAR SINGH RANDHAWA Date Health Program Description Amount Invoice# IN0296901 --Date of Invoice: 9/26/2017 I IIIIIII IIIIII III VIII VIII VIII VIII VIII IIIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII 9/26/2017 1921 HMBP-Regular-Primary Location $ 330.00 9/26/2017 1922 CERS Processing Fee $ 25.00 9/26/2017 2220 SM HW GEN<5 TONS/YR $ 249.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2301 UST STATE SURCHARGE FEE $ 20.00 9/26/2017 2360 UST-PER TANK FEE $ 152.00 9/26/2017 2360 UST-PER TANK FEE $ 152.00 9/26/2017 2360 UST-PER TANK FEE $ 152.00 9/26/2017 2360 UST-PER TANK FEE $ 152.00 9/26/2017 2361 UST FACILITY $ 641.00 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 12/15/2017 9987 Haz Mat Program Penalty Fee $ 33.00 12/15/2017 9994 PERMIT FEE PENALTY $ 641.00 12/15/2017 9994 PERMIT FEE PENALTY $ 249.00 12/15/2017 9994 PERMIT FEE PENALTY $ 152.00 12/15/2017 9994 PERMIT FEE PENALTY $ 152.00 12/15/2017 9994 PERMIT FEE PENALTY $ 152.00 12/15/2017 9994 PERMIT FEE PENALTY $ 152.00 Total for this Invoice $ 3,513.00 PAST DUE Invoice# IN0303357---Date of Invoice: 11/29/2017 I IIIIIII IIIIII III VIII IIIII IIIII(IIII VIII VIII IIIII IIIII IIII IIIIII 111111111 IIII Hrs Employee 10/5/2017 2361 306-FOLLOW UP FOR NON-COMPLIANCE 0.10 HO $ 15.20 2/15/2018 9988 SERVICE CHARGE PENALTY $ 1.52 Total for this Invoice $ 16.72 PASS'DUE TOT DUE this Billing Period $ 3,529.72 AR 16 20!8 8A1,ENVIRONIN CO 5254.rpt HEALTHpE ARTMEN?'