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SAN JUAQUIN GUUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTJWT _ Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 IR COPY <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0017146 <br /> Facility ID FA0010146 <br /> Date Printed 1 1/29/2009 <br /> C&S ONE HOUR MARTINIZING RE : C&S ONE HOUR MARTINIZING <br /> 5756 PACIFIC AVE STE#1 5756 PACIFIC AVE STE 1 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> OWNER : PATEL, CHANDRAKANT B "CHARLES" <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184330---Date of Invoice: 1/29/2009 I IIIIIII IIIIII III IIIII IIIII IIIII VIII VIII VIII VIII IIIII IIIII IIII IIIIII VIII IIII IIII <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 255.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 492.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 492.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB, 6 2009 <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 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 />