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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPI RTN" - Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0006129 <br /> Facility ID I FA0005534 <br /> Date Printed 4/22/2005 <br /> HARBIR S BAL RE : THE SERVICE STATION <br /> THE SERVICE STTION 1100 W 11TH ST <br /> 1100 W 11TH ST TRACY, CA 95376 <br /> TRACY, CA 95376 <br /> OWNER : BAL, HARBIR S <br /> Health <br /> Date Drn�ram escriptio _ _. Amount <br /> Invoice# IN0128612---Date of invoice : '1/24/2005 I(IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII IIIII IIII IIII <br /> 1/24/2005 2220 SM HW GLN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZ AT FEE $ 130.00 <br /> 1/24/2005 2399 UNIFIED F ROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> 3/15/2005 9987 Haz Mat P ogram Penalty Fee $ 13.00 <br /> 4/4/2005 9999 AYMEN ($ 354.00) <br /> Total for this Invoice $ 13.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 13.00 <br /> PAYMENT <br /> RECEIVED <br /> PENALTY OWING MAY 3 1 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks P YABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For DES/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 /> 5255 rpt <br />