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f <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMM*rNT Page 1 <br /> 600E MAIN STREET COPY STOCKTON, CA 95202 <br /> INVOICE `���\ AccountlD AR0034306 <br /> Facility ID FA0019292 <br /> Date Printed 4/30/2012 <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# IN0226079--Date of Invoice: 1130/2012 IIIIIIIIIIIIIIIIIIIIIIVIIVIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIN <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 270.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9967 Haz Mat Program Penalty Fee $ 27.00 <br /> Totalfor this Invoice $ 346.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 346.00 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <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 />