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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTRW <br /> 600 E MAIN STREET w <br /> STOCKTON, CA 95202 ®�� <br /> Phone: (209) 468-3420 <br /> INVOICE Amount ID AR 003 5543 <br /> Facility ID F FA0019964 <br /> Date Printed 4/28/2011 <br /> V&W DRILLING INC RE : V&W DRILLING INC <br /> 3806 DUCK CREEK DR 3806 DUCK CREEK DR <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : ROBERT VICKERY <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0213851 --Date of Invoice: 1/31/2011 IIIIIIIIIIIIiIIIIVIIIIIIIIVIIIVIIIVIIIIIIIIIIIIIVIIIVIIIIIIIIIIIIIIIIIIINIIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 285.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> Total forthis Invoice $ 362.50 <br /> Payment Due Date 3/212011 <br /> TOTAL DUE this Billing Period $ 362.50 <br /> Ea o- <br /> I SR L)UL <br /> Delinquent changes <br /> will be forwarded to <br /> .-.,9 EfM C.`JT-A <br /> ir. 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!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 />