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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 INVOICE <br /> �®TY <br /> Account ID I AR0024995 <br /> Facility ID FA0014688 <br /> Date Printed F 4/30/2012 <br /> HALL, CLIFF RE: DANS TIRE&AUTO REPAIR LLC <br /> DANS TIRE&AUTO REPAIR LLC 1533 S STOCKTON ST <br /> 1533 S STOCKTON ST LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : HALL,CLIFF <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0224718---Date ofInvoice: 113 012 01 2 IIIIIIIIIIIIIIVIIIIillullllllllllllVllllilllllllllllllllllllli <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 115.00 <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 /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 11.50 <br /> Total for this Invoice $ 175.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 175.50 <br /> PAS DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECTIONS <br /> 4.. 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 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 />