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600 E MAIN STREET-STOCK ^� v� • • <br /> Phone: ON,209 46 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE c: <br /> U RECEIVED A=unt ID AR0016291 <br /> a, "� <br /> 2A Facility ID FA0009291 <br /> SAN JOAQUIN COUNTY <br /> OFFICE OF EMERGENCY SERVICES Date Printed LMENEEMMOMMEMA <br /> 5/26/2011 <br /> TEDS WELDING & REPAIR RE : TEDS WELDING & REPAIR <br /> PO BOX 726 8932 E HWY 12 <br /> VICTOR, CA 95253 VICTOR, CA 95253 <br /> OWNER : G WILLIAM BRAUN <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0210755---Date of Invoice: 1/31/2011 1111 lll11 1 111 f ll�ll'lull lul lul ll ll'III LII VIII III'l'll1llll llll lll1 <br /> 1/28/2011 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 285.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE.SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> 4/15/2011 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 788.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 788.50 <br /> Delinquent Charles <br /> will be orwar"G' is <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 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 /> i2i4.rpt <br />