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9A1l JUAUUIN GUUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTM�T • Page 1 <br /> .600 E MAIN STREET <br /> STOCKTON, CA 95202 ®�T ij <br /> Phone: (209)468-3420 ' p(� <br /> INVOICE ' J I Account ID FAR0016588 <br /> J Facility ID F FA0009588 <br /> Date Printed F 4/28/2011 <br /> DA ARCHER EXCAVATING RE : DA ARCHER EXCAVATING <br /> 5948 E WATERLOO RD 775 W SECOND ST <br /> STOCKTON, CA 95215 STOCKTON, CA 95206 <br /> OWNER : ARCHER, DAVID R <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0210608—Date of Invoice: 1/31/2011 11111111111p111111111111ININ <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 345.00 <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 $ 34.50 <br /> Total forthis Invoice $ 428.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 428.50 <br /> L4-' U <br /> DelingUent charges <br /> will he forwarded to <br /> C0LLEC 1016`x3 <br /> it 30 days , . <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> ffit <br /> ies will be added to all Permit Fees For DES/HMMP Fees For all SERVICE FEES 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 />