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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTh <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />LOVES COUNTRY STORE <br /> <br /> <br />Page 1 <br />Account ID <br />AR0020960 <br />Facility ID <br />FA0012659 <br />Date Printed <br />L 1/26/2007 <br />RE: LOVES COUNTRY STORE <br />1553 COLONY RD <br />RIPON, CA 95366 <br />OWNER: LOVES COUNTRY STORES OF CA <br />Date Health <br />Program Description <br />Amount <br />Invoice # IN0157248 -- Date of Invoice : 1/25/2007 <br />1/25/2007 <br />2220 <br />SM HW GEN <5 TONS/YR <br />1/25/2007 <br />2244 <br />2007 HAZMAT FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2301 <br />UST STATE SURCHARGE FEE <br />1/25/2007 <br />2360 <br />ADDITIONAL UST <br />1/25/2007 <br />2360 <br />ADDITIONAL UST <br />1/25/2007 <br />2360 <br />ADDITIONAL UST <br />1/25/2007 <br />2360 <br />ADDITIONAL UST <br />1/25/2007 <br />2362 <br />UST FACILITY & 1 TANK <br />1/25/2007 <br />2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />r,ECEIVED FLb 1 b LUPI <br />IUv <br />IST 0 -RE tt <br />INV. DATr _ G.L.# <br />I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII <br />$ <br />IIIIII VIII IIII IIII <br />206.00 <br />$ <br />285.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />125.00 <br />$ <br />125.00 <br />$ <br />125.00 <br />$ <br />125.00 <br />$ <br />500.00 <br />$ <br />24.00 <br />Total for this Invoice) $ 1,590.00 <br />Payment Due Date 2/25/2007 <br />TOTAL DUE this Billing Period) ,$ 1,590.00 <br />PAI' M E N]`i <br />RECEIVED <br />a :9�, FEB 2 0 2007 <br />For Love's Travel . ,)iotas, Inc. <br />DHctor Env. Affairs <br />(0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />iC ENTERED FFEB j- J 2007 <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 />D2�14.rpl <br />