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SAN JOAQUIN COUNTY Page 1 <br /> ` ENVIRONMENTAL HEALTH DEPARTfVWT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> n ,/ f <br /> N 7B'qy®IlC E yyti � ArWunt ll] F AR0037485 <br /> !l Facility ID EA002Q866 <br /> Date Printed 4/30/2012 <br /> DEBRUIN CONSTRUCTION INC RE : DEBRUIN CONSTRUCTION INC <br /> PO BOX 1355 1045 W CHARTER WAY' <br /> FRENCH CAMP,CA 95231 STOCKTOWCA 95206' <br /> OWNER : RICHARD DEBRUIN <br /> Health <br /> Date program Description Amount <br /> Invoice# 10226474---Dateoflnvoice: 1130/2012 : IIIIIIfIIIII�II�IIIIlllil{�I��IIiIII�lII1�1I[I�11iII1l1I1llliill1Ill1Il1I III IN <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 375.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAG STATE SURCHARGE FEF $ 24-00 <br /> 1/2712012 ERSC ELECTRONIC RFPQRTtNG STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 37.50 <br /> Total for this Invoice $ 461.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 461.50 <br /> PAST D"! U <br /> Delinquent charges <br /> will be forwarded t0 <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 OES 1 HMMP Fees For all SERVICE FEES <br /> at the Rate of 100 1/.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 />