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JMIN JUAW11JIN I,.UUN I T <br /> ENVIRONMENTAL HEALTH DEPARTMr"T Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003361 <br /> Facility ID FA0002324 <br /> Date Printed 1 1/26 <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# IN0157293---Date of Invoice: 1/25/2007 IIIIIIIIIIIIIIIII IIIIIII�IIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIII 111111111 <br /> IIII <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 85.00 <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 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,110.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $; 1,1'10.00 <br /> PAYMENT <br /> �En 20� <br /> SAN 30AQUIN COUNTY <br /> ENVIFjONMENTAL <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 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 />