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ENVIRONMENTAL HEALTH DEPARTMENT rage I <br /> 600 E MAIN STREET • • <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE �'j DLMEMMMEEMMOMMU <br /> Account ID AR 0025009 <br /> Facility ID FA0014702 <br /> Date Printed 5/27/2009 <br /> DIAZ, JORGE JR RE : COALCOMAN AUTO REPAIR <br /> COALCOMAN AUTO REPAIR 1042 S SINCLAIR AVE <br /> 1042 S SINCLAIR AVE STOCKTON, CA 95215 <br /> STOCKTON, CA 95215 <br /> OWNER : DIAZ, JORGE JR <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0185654---Date of Invoice : 1/29/2009 IIIIIII III VIII VIIVIIVI VIIVII VIM VIII IIIIIIIVII VIII <br /> 1/29/2009 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 100.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 560.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 560.00 <br /> jELOUF <br /> DeUl-ji ,uent cliargto�sq <br /> fi I'.� jtLa�yili�Fvi,1 LC <br /> Er' 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 DES 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 />