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JOAQUIN COUNTY Page 1 <br /> /IRONMENTAL HEALTH DEPARTMEf <br /> i E WEBER AVE -3RD FLOOR <br /> OCKTON, CA 95202 <br /> hone: (209) 468-3420 <br /> INVOICE AccountlD AR0016801 <br /> LMMMMOMMOMENA <br /> Facility ID FA0009801 <br /> Date Printed 2/5/2004 <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 Amount <br /> Prnnram Description <br /> Invoice# IN0115793---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 $ 255.00 <br /> 2/4/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 479.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $ 479.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 7 20^4 <br /> SAN JOAQUIN COUN'i Y <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 /> 5255.mt <br />