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� a <br /> T SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMWT Page <br /> 600 E MAIN STREET - <br /> STOCKTON, CA 95202 <br /> Phone: (209)4683420 <br /> INVOICE AccouniID AR0037485 <br /> Facility ID FA0020866 <br /> Date Printed 1/30/2012 <br /> DEBRUIN CONSTRUCTION INC RE : DEBRUIN CONSTRUCTION INC <br /> PO BOX 1355 1045 W CHARTER WAY <br /> FRENCH CAMP CA 95231 STOCKTON,CA 95206 <br /> OWNER : RICHARD DEBRUIN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0226474---Date of Invoice: 1130/2012 I Illllll111111 III VIII VIII III11 VIII VIII III1111I11IIIII IIIII1111111111111111111 IN <br /> 1/27/2012 2244 2012 HAZMAT FEE" $ 375.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/2712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> Total forthis invoice $ 424.00 <br /> Payment Due Date 2/2912012 <br /> TOTAL DUE this Billing Periodl 424.00 <br /> r J <br /> r <br /> E <br /> f <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 1 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 Daysafter the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br /> i - " <br />