Laserfiche WebLink
600 E MAIN STREET <br /> STCCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE ' 4'0 Account ID AR0035498 <br /> FaciI4 ID FA0019919 <br /> LMMMMMMMMOMA <br /> Date Printed 11/30/2009 <br /> BAJA FRESH MEXICAN GRILL#185 RE : BAJA FRESH MEXICAN GRILL#185 <br /> 4230 KIERNAN AVE STE 105 5350 PACIFIC AVE#J-2 <br /> MODESTO, CA 95356 STOCKTON, CA 95207 <br /> OWNER : MARTIN LOPEZ <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0193967-Date of invoice: 9/24/2009 �1111111111111 H 111111111111111 A1111111111111111111111111 1IN311111111111IN <br /> 9/24/2009 2244 2009 HAZMAT FEE PLUS 3 YEARS BACK BILLING $ 1,020.00 <br /> 11/15/2009 9987 Haz Mal Program Penalty Fee $ 102.00 <br /> Total forthis Invoicel $ 1,122.00 <br /> Payment Due Date 10/24/2009 <br /> TOTAL DUE this Billing Period $ 1,122.00 <br /> 1?4AST ' <br /> Delinquent charges <br /> Will be forwarded to <br /> COLLECTIONS <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 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 />