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5AN JUAUUIN CUUN I Y . Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMA <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> INVOICE x \\lb AccountlD AR0016097 <br /> COPY iIC� <br /> Facility ID FA0009097 <br /> Date Printed 5/30/2012 <br /> NIN, BILL <br /> RE : BIG O TIRES#31 <br /> CROTIRES#31 810 E YOSEMITE AVE <br /> BIG N <br /> 810 E YOSEMITE AVE MANTECA, CA 95336 <br /> MANTECA, CA 95336 <br /> OWNER : CRONIN, BILL/CHRISTENSEN, E <br /> Health Amount <br /> Date Program Description <br /> Invoice# IN0223171 ---Date ofInvoice: 1130/2012 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIIIIIIIIIIIIIIIIII <br /> $ 213.00 <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 85.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 24.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 25.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 8.50 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 213.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY <br /> Total for this Invoice $ 568.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 568.50 <br /> Pia `$' DUE <br /> Delinquent charges <br /> will he forwarded to <br /> COLLECTGNS <br /> in 30 days. <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> ffa:ill be added to all Permit Fees For DES/HMMP Fees ForallSERte of 100%ofthe Base Fee Penaltieays after the Due Data <br /> 45 Days after the Invoice Date Y <br />