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SAN JOAQUIN COUNTY PUBLIC LTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DAN <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0017067 <br /> FA0010067 <br /> Facility IDLWOMMMMMMMMMI <br /> Date Printed 2/16/01 <br /> TERRY MCGREGOR RE : JIFFY LUBE <br /> JIFFY LUBE 4715 N WEST LN <br /> 4715 N WEST LN STOCKTON CA 95210 20 <br /> STOCKTON CA 95210 OWNER: JIFFY LUBE <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0080366—Date of Invoice: 1130101 <br /> 1/30/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 3/1812001 <br /> TOTAL DUE this Billing Period1 10.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Pin aheswill e added to all enmt Fees Fora <br /> ll SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days afterthe Invoice Date and each 30 thereafter <br /> 5255.rpt <br />