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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE -3RD FLOOR — <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0022732 <br /> Facility ID F FA0013598 <br /> Date Pnnted F1/24/2005 <br /> LUMMONEENNOMMO <br /> AMERICAN FIRE SYSTEMS INC RE : AMERICAN FIRE SYSTEMS INC <br /> PO BOX 2693 1102 BLACK DIAMOND WAY <br /> LODI, CA 95241 LODI, CA 95240 <br /> OWNER : MOATS, BUDDY <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128547—Date of Invoice: 1/24/2005 pp1pp11p111p11Hill pp1p1 <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 255.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ /,�" 479.00 <br /> Payment Due Date 2/23/2095' <br /> TOTAL DUE this Billing Period $ 479.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 1 5 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 /> 5255.rpt <br />