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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMW Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD F A—RO-003195 <br /> Facility ID FA0003617 <br /> Date Printed 1/29/2009 <br /> LIMMEMEMEMEMMINA <br /> RICK CISSELL, MGR RE : CAL WEST CONCRETE CUTTINGS INC <br /> CAL WEST CONCRETE CUTTINGS INC 1153 VANDERBILT CIR <br /> 1153 VANDERBILT CIR MANTECA, CA 95337 <br /> MANTECA, CA 95337 <br /> OWNER : BIRCH,WELDON <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0184108--Date of Invoice: 1129/2009 (IIIIIIIIII VIIVIIVIIIIIIIIIIIVIIVIIIIIIIIIIIIIIIIIIII VIIIIIIIIIII <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 300.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 537.00 <br /> Payment Due Date 2/28/2009 <br /> TOTAL DUE this Billing Period $ 537.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 12 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 />