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s AN JUAUUIN UUUN 1 Y • • Pagel <br /> 'ENVIRONMENTAL HEALTH DEPARTMEAT <br /> 1868 E HAZELTON AVENUE ` <br /> STOCKTON, CA 95205 tt'�\ <br /> 'NVO'Cb6c Account ID AR0017109 <br /> COPY /�\ FA0010109 <br /> Facility ID <br /> Date Printed 5/30/2012 <br /> RAMIREZ AUTOMOTIVE RE : RAMIREZ AUTOMOTIVE <br /> 811 N SACRAMENTO ST 811 N SACRAMENTO ST <br /> LODI, CA 95240 LODI, CA 95240 <br /> OWNER : JUAN RAMIREZ JR <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0223489---Date of Invoice: 1/30/2012 IIIIIIIIIIIIIIIII IIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 - <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 /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total forthis Invoice $ 475.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 475.00 <br /> PAST D U E <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 be a/ ed at Fees <br /> For all SERVICE FEES <br /> Penalties will be added at the Rate of 10 <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% 60 Das after the Invoice Date and each 30 Days thereafter <br /> 30 Days after the Due Date 45 Days after the Invoice Date Y <br />