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SAN JOAQUIN COUNTY ENVIRONML.. fAL HEALTH DEPARTMENT <br />304 E WEBER AVE - 3RD FLOOR <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br />COUNTRY CLUB SHELL <br />COUNTRY CLUB SHELL* <br />2575 COUNTRY CLUB BLVD <br />STOCKTON CA 95204 <br />Health <br />Date Program Description <br />Invoice # IN0090817 --- Date of Invoice : 1/22/2002 <br />Page 1 <br />Account ID AR0008426 <br />Facility ID FA0006439 <br />Date Printed 3/28/2002 u <br />RE: COUNTRY CLUB SHELL* <br />2575 COUNTRY CLUB BLVD <br />STOCKTON CA 95204 <br />OWNER: EQUILON LLC ENTERPRISES LLC <br />Hrs Employee - Amount <br />1/22/2002 <br />2399 <br />UNIFIED PROGRAM FAC STATE SERVICE FEE <br />$17.50 <br />1/22/2002 <br />2220 <br />SM HW GEN <5 TONSNR <br />$200.00 <br />1/22/2002 <br />2362 <br />Underground Storage Tank EH Operating Permit Fee <br />Tank # 005 <br />$500.00 <br />1/22/2002 <br />2301 <br />UST STATE SURCHARGE <br />$10.00 <br />1/22/2002 <br />2360 <br />Underground Storage Tank EH Operating Permit Fee <br />Tank # 007 <br />$125.00 <br />1/22/2002 <br />2301 <br />UST STATE SURCHARGE <br />$10.00 <br />1/22/2002 <br />2360 <br />Underground Storage Tank EH Operating Permit Fee <br />Tank # 008 <br />$125.00 <br />1/22/2002 <br />2301 <br />UST STATE SURCHARGE <br />$10.00 <br />Total for this Invoice <br />$997.50 <br />Payment Due Date 3/ <br />TOTAL DUE this Billing Period <br />$997.50 <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 <br />For all SERVICE FEES <br />Penalties will be added at the Rate of 10% <br />at the Rate of 100% of the Base Fee <br />60 Days after the Invoice Date and each 30 thereafter <br />30 Days after the Due Date <br />PA -,%,;.T DUE <br />WE %� PAYME�--N TODAY! YUR <br />PAYMENT <br />RFC-j\/E0 <br />SAN 30400IN COUNiY <br />PUBLIC Htwm SE'Mus <br />�410N <br />ENVIRONMEN��`•l h` 1�1. D <br />5255.rpt <br />