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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTM 'T <br /> 304 E WEBER AVE -3RD FLOOR — <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016876 <br /> Facility ID FA0009876 <br /> Date Printed F 1/24/2005 <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 /> Prooram Description Amount <br /> Invoice# IN0128125—Date of Invoice: 1/24/2005 IIIIIIIIIIIIIIIIIVIIIIIIIIII VIIVIIVIIIVII III VIII IN 11111111111 IIII IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 115.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 339.00 <br /> Payment Due Date 2123/2005 <br /> TOTAL DUE this Billing Period $ 339.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 3 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 DES/HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 101 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 /> ilii rpt <br />