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SAN JOAQUIN COUNTY j� <br /> ENVIRONMENTAL HEALTH DEPARTMENT OlJ Page 1 <br /> 1868 E HAZELTON AVENUESTOCKL J v <br /> Phone: ON,209 46 95205 <br /> Phone: (209 468-3420 <br /> INVOICE �c�j�J � AcwunlID AROoz5417 <br /> 4� Fadliry 10 FA0014891 <br /> Date Pnnted 2/28/2013 <br /> VILLAVICENCIO, SANTIAGO RE : QUALITY TUNE UP#11 <br /> QUALITY TUNE UP#11 7730 HOLMAN RD <br /> <br /> <br /> OWNER : VILLAVICENCIO, SANTIAGO <br /> Date Health - <br /> Program Description Amaunl <br /> Invoice# IN0236aa6—Date ofInvoice: 211/2013 III�IIIIII�III �I�IIIIIIIIilll�ll"'II1I1IIII'IIII1IIIN <br /> 2/1/2013 1920 HMBP-Common Materials S 130.00 <br /> 21U2013 2220 SM HW GEN<5 TONS,YR s 213.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SU RCHARGE FEE s 35.00 <br /> Total for thia Invoice $ 378.00 <br /> Payment Due Date 313/2013 <br /> - – —— -- _ TOTAL DUE thisBilling Period 5 378.00 <br /> PA Y&TE <br /> RFCE QED <br /> 44R 19 , - <br /> oor <br /> igTouMy <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 HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added atthe Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Data 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.:pl <br /> L'd LL£L£LV60ZL LLdneuntQllren0 d9b:ZL£L90Jan <br />