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ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AROO1 0067 <br /> Facility ID FA0011067 <br /> Date Printed 5/27/2009 <br /> FARIAS AUTO REPAIR RE : FARIAS AUTO REPAIR <br /> <br /> STOCKTON, CA 95205 <br /> OWNER : FARIAS, JOSE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184837---Date ofInvoice: 1/29/2009 �111111111111111111111 HE 11111111111111111111111111111111111 IN 11111111111 IN 1111 <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 100.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 560.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 560.00 <br /> ( AST U <br /> ral <br /> 1Y.t {� if7{fnr�,Y Lo <br /> I� 30 <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/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 />