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JAN JUAVUIN UUUN I Y <br />ENVIRONMENTAL HEALTH DEPARTM' T Page 1 <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 COPY <br />Phone: (209) 468-3420 <br />INVOICE Account ID AR0008426 <br />Facility ID FA0006439 <br />Date Printed 1/26/2007 <br />CALIFORNIA FUEL SUPPLY INC RE: COUNTRY CLUB 76 GAS STATION* <br />COUNTRY CLUB 76 GAS STATION* 2575 COUNTRY CLUB BLVD <br />587 YGNACIO VALLEY RD STOCKTON, CA 95204 <br />WALNUT CREEK, CA 94596 <br />OWNER: CALIFORNIA FUEL SUPPLY INC <br />Date Health <br />Program Description Amount <br />Invoice # IN0159682 --- Date of Invoice : 1/25/2007 <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 />2350 <br />ADDITIONAL UST - 2481 COMPLIANT <br />1/25/2007 <br />2350 <br />ADDITIONAL UST - 2481 COMPLIANT <br />1/25/2007 <br />2352 <br />UST FACILITY & 1 TANK - 2481 COMPLIANT <br />1/25/2007 <br />2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />IIIII IIIII IIIII IN <br />$ <br />11111111111 IN IN <br />15.00 <br />$ <br />15.00 <br />$ <br />15.00 <br />$ <br />125.00 <br />$ <br />125.00 <br />$ <br />500.00 <br />$ <br />24.00 <br />Total for this Invoice $ <br />819.00 <br />Payment Due Date <br />2/25/2007 <br />/"819.001 <br />TOTAL DUE this Billing Period <br />$ <br />PAYMENT <br />RE_CEIVED <br />FEB 2 n <br />SAN JOr' QUIN COi1r�TY <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 />5254.rpt <br />