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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMq Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0017931 <br /> Facility ID FA0010931 <br /> Date Printed 1 2/5/2004 <br /> NICK LANG & HEATHER MORAL RE : AMERICAN TIRE &AUTO REPAIR <br /> AMERICAN TIRE &AUTO REPAIR 8288 S EL DORADO ST <br /> PO BOX 778 FRENCH CAMP, CA 95231 <br /> FRENCH CAMP, CA 95231 <br /> OWNER : LANG, NICK M &JOHN F, TTEE <br /> Date Health <br /> l <br /> Program Description_ _ J Amount_ I <br /> Invoice# IN0116111 ---Date of Invoice: 2/4/2004 <br /> 2/4/2004 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZMAT FEE $ 115.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 339.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 339.00 <br /> tAAR 0 294 <br /> Nom` <br /> SAA JO","OT'. <br /> IN GOU T <br /> MENTHE <br /> ��TH DEpARTMEN <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 />