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SAN JV QUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMI • Page 1 <br /> 3tl4 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016601 <br /> Facility ID F FA00 99809 <br /> Date Printed 1 1/30/2006 <br /> DEAN BURNSIDE RE : WOODLAKE CLEANERS <br /> WOODLAKE CLEANERS 2401 W TURNER RD 220 <br /> 2401 W TURNER RD#220 LODI, CA 95242 <br /> LODI, CA 95242 <br /> OWNER : BURNSIDE, DEAN <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IND142828--Date of Invoice : 1/27/2006 111111III1III VIII11I1111I VII VIIVIIIVIIIVII VIII IIII 11111111111 IIII IIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 255.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 479.00 <br /> Payment Due Date 3111 <br /> TOTAL DUE this Billing Period L479;00 _1 <br /> PAlWVIEN_f <br /> PEMIGEIVED <br /> FEBREB 2 7 2006 <br /> SAN J6AN JOAQUIN COUNTY <br /> ENVIR ENVIRONMENTAL <br /> HEALTHEALTH DEPARTMENT <br /> Please make Checks PAYABLE to: 'EHO' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For DES I 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 />