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SAN JOAQUIN COUNTY RECEIVED Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMr T <br /> 600 E MAIN STREET — APR 2 0 2009 <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 SAN JOAQUIN COUNT( <br /> INVOICE OFFICE OF EMERGENCY SERVICES AccountID AR0034306 <br /> Facility ID FA0019292 <br /> -h/ l Date Printed 3/25/2009 <br /> FERMIN ALUSTIZA RE : FERMIN ALUSTIZA <br /> 8250 SEGARINI CT 820 CHANNEL ST <br /> STOCKTON, CA 95209 STOCKTON, CA 95202 <br /> OWNER : FERMIN ALUSTIZA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0187166—Date of Invoice: 1129/2009 IIIIIIIIIIIIIIIIIIVIIIVIIVIIVIII VIII VIIVIIIIIIIiIIIIIVIIIIIII <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 270.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice $ 321.00 <br /> Payment Due Date 212812009 <br /> TOTAL DUE this Billing Period $ 321.00 <br /> ou <br /> Delinquent charges <br /> twill be forwarded to <br /> C 010L E6_7rr@ONS <br /> in 30 dayS. <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 />