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SAN JOAQUIN COUNTY <br /> -ENVIRONMENTAL HEALTH DEOt RENT Page 1 <br /> 30: E WEBER AVE -3RD FLOO <br /> STOCKTON, CA 9 <br /> <br /> count ID AR0024977 <br /> Facility ID FA0014678 <br /> Date Printed 1/30/2006 <br /> ESFANDIARY, FRED RE : MR CAFE <br /> MR CAFE 713 N EL DORADO ST <br /> PO BOX 1370 STOCKTON, CA 95202 <br /> STOCKTON, CA 5201 <br /> OWNER : ESFANDIARY, FRED <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0144585---Date of Invoice: 1/27/2006 1111111111 HE 111111111111111111111111 IN IN <br /> 1/27/2006 2220 SM HW EN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 H MAT FEE $ 85.00 <br /> 1/27/2006 2301 UST STA E SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STA E SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STA E SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIO AL UST $ 125.00 <br /> 1/27/2006 2360 ADDITIO AL UST $ 125.00 <br /> 1/27/2006 2362 UST FAC LITY& 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED ROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total forthis Invoice $ 1,104.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 1,104.0 <br /> �CSV <br /> SAN JOAJ0N <br /> ENV1RONPJ4Ei-WEN1. <br /> t-tEA1 TN pEPAR <br /> Please make Checks PAY ABLE 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 />