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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMF"T Page 1 <br /> 600 E MAIN STREET _ <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0022618 <br /> Facility ID F FA0013514 <br /> Date Pnnted F 1/29/2009 <br /> Imemoommmommommm <br /> LARA, SALLY RE : COLLICUT ENERGY SERVICES INC <br /> COLLICUT ENERGY SERVICES INC 3955 E ARCH RD <br /> 3955 E ARCH RD STOCKTON, CA 95215 <br /> STOCKTON, CA 95215 <br /> OWNER : COLLICUT ENERGY SERVICES INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN01 84601 —Date of Invoice: 1129/2009 11111 Fill pill IIIII IIIII III 1111111111 Hill 11111111 <br /> 1/29/2009 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 330.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 567.00 <br /> Payment Due Date 212812009 <br /> TOTAL DUE this Billing Period $ 567.00 <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 /> i2�4.rpt <br />