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SAN JOAQUIN COUNTY <br /> Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTM <br /> E(b <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICEARoo17s8�� <br /> AccountlD <br /> Facility ID FA0010987 <br /> Date Printed 1, 3/9/2004 <br /> PACIFIC COAST SUPPLY LLC RE : ANDERSON TRUSS <br /> ANDERSON TRUSS 2050 E LOUISE AVE <br /> 4290 ROSEVILLE RD LATHROP, CA 95330 <br /> NORTH HIGHLANDS, CA 95660 <br /> OWNER : PACIFIC COAST SUPPLY LLC <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0116129---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 $ 315.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 539.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Periodl $ 539.00 <br /> FIECUVrC <br /> LIAR 9 ?t+( <br /> SAN JOAQUIN COLIN i Y <br /> ENVIRONMENTAL <br /> 61EALTH DEPARTML14T <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 />