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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMEI` <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID ARoo,s87s <br /> Facility ID FA0009876 <br /> Date Printed 1126/2007 <br /> DEJONG, BLAINE RE : BLAINE DEJONG'S AUTO WORKS INC <br /> BLAINE DEJONG'S AUTO WORKS INC 324 N CLUFF AVE <br /> 324 N CLUFF AVE LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : BLAINE DEJONG'S AUTO WORKS INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0156710---Date of Invoice: 112512007 IIIIIIIIIIIIII IIIIIIIIIIIII VIII VIII IIIIIIIIII VIIIVIII VIII IIIIIIIIII IIIIIIIII IIII <br /> 1/25/2007 2220 SM HW GEN<5 TONSNR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 115.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 345.00 <br /> Payment Due Date 212512007 <br /> TOTAL DUE this Billing Period $ 345.00 <br /> PA� <br /> RA�A4VV-- 71 <br /> r <br /> AFEe 2 Zoog <br /> 3 �" '[ y T R0-COUh,7y <br /> H�EpgR'NMT� <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 /> 5254.rpt <br />