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JAN JUAWUIN L UUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF 'T 9 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0003361 <br /> Facility ID FA0002324 <br /> Date Printed 1/30/2006 <br /> MARIGOLD SHELL RE : MARIGOLD SHELL <br /> 6131 PACIFIC AVE 6131 PACIFIC AVE <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> OWNER : TRAN, HUNG THANH <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143461 ---Date of Invoice : 1/27/2006 1MIT 111111 111 IIIE 11111 11111 11111 11111 11111 111 111 11111 11111 1111 111111 11111 1111 IN <br /> 1/27/2006 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 85.00 <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 $ 1,104.00 <br /> Payment Due Date 3/1/20 6 <br /> TOTAL DUE this Billing Period $ 1,104.0 <br /> FEB .1 0 <br /> SAN JOAOUIN{:rte, <br /> HEALTH. ' <br /> hEPARTiv�.__. <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 />