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SAN JOAQUIN COUNTY ../ Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> INVOICE yj Accounll0 AR0016809 <br /> ✓✓/� Facility ID FA0009809 <br /> Date Printed 4/30/2012 r <br /> FIREWORKS& STAGE FX AMERICA I RE: FIREWORKS&STAGE FX AMERICA <br /> PO BOX 488 32727 S CORRAL HOLLOW RD <br /> LAKESIDE, CA 92040 TRACY, CA 95376 <br /> OWNER : FIREWORKS &STAGE FX AMERICA <br /> Dale Health <br /> Program Description Amount <br /> Invoice# IN0223103---Date of Invoice: 1/30/2012 1111111 IIIIIIIII IIIII IIIIIIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIIIIIIIIIIIIIIIII IIII <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 9987 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 /> pAd4.3T DUE <br /> Delinquent charges <br /> will be forwarded to <br /> p,r in a® 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/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 />