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SAN JUAWUIN UUUN I T <br /> ENVIRONMENTAL HEALTH DEPARTM"T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKPhone: ON,209 46 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Amount ID I AR0004604 <br /> Facility ID F FA0002469 <br /> Date Printed F 1/30/2006 <br /> MS #6516 TAX NASC RE : SAFEWAY FUEL CENTER#2707 <br /> SAFEWAY FUEL CENTER#2707 6425 PACIFIC AVE <br /> <br /> <br /> OWNER : SAFEWAY INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# ING142641 ---Date of Invoice: 1/27/2006 I VIII I I I I IIIIII II VI I VIIIV IVIIIVII VII VII VI IIIIII III 11111 11111111 <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 100.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,119.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period 1,119.0 <br /> PAY INA <br /> REC-M .i <br /> FEB 17 <br /> SAN JOAQUIN CCUIv, <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 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 /> 5254.rpt <br />