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,AN JUAk4UIN UUUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMr ..- <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> (/�.� AR0016402 <br /> INVOICE COPY � J Account <br /> 1. Y FacilitylD FA0009402 <br /> Date Printed 5/30/2012 <br /> COLLINS ELECTRICAL CO INC RE : COLLINS ELECTRICAL CO INC <br /> 611 W FREMONT ST 611 W FREMONT ST <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 <br /> OWNER : COLLINS ELECTRICAL CO <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223288--Date ofInvoice: 1/3 012 01 2 IIIIIIIIIIIIIIVIIVIIIVIIIVIIVIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 360.00 <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 /> 2/27/2012 9999 PAYMENT ($ 409.00) <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice I $ 426.00 <br /> t� PAST DUE <br /> I <br /> P . <br /> WE WOULD fi,i-`'ii i:': "i'E YOUR <br /> TOTAL DUE this Billing Period $ 426.00 <br /> PAY 4''r'i':INT!UPA`!I <br /> PAS` ' DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECTIONS <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 I 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 add,deeda f,tb-q 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 />