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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr Page 1 <br /> 600 E,MAIN STREET rr� i' <br /> STOCKTON, CA 95202 V <br /> Phone: (209) 468-3420 <br /> INVOICE � <br /> Account ID AR0025410 <br /> C� Facility ID FA0014884 <br /> Gb Date Printed 3/31/2010 <br /> MAIN ST qUFFLER \E : MAIN ST MUFFLER <br /> 3403E IN ST C 3403 E MAIN ST STE C <br /> STOCK ON, CA 95205 STOCKTON, CA 95205 <br /> / OWNER : EULALIA PENA <br /> Date Health <br /> Proaram Description Amount <br /> Invoice# IN0199328---Date of Invoice: 2/2/2010 11111 11111 11111 11111 lit 1111 111111 11111 1111 IN <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this Invoice $ 355.50 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 355.50 <br /> 1 <br /> E WOULD <br /> MENT TQ®CIAYE YO <br /> WUR <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/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 /> i?i4.rpt <br />