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SAN JOAQUIN COUNTY PUBLIC HEAFH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVISI j <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account I AR0017067 <br /> Facility ID FA00100637 <br /> LMMMOOMMMMMI <br /> Date Printed4/25/00 <br /> STUART BURNHAM RE: Q-LUBE <br /> Q-LUBE 4715 N WEST LN <br /> 3927 MC HENRY AVE <br /> MODESTO CA 95356 OWNER: STUART BURNHAM <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0070608---Date of Invoice: 4/19/00 <br /> 4/19/2000 2220 SM HW GEN<5 TONSNR $100.00 <br /> 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 5125/2000 <br /> TOTAL DUE this Billing Period 1 0.00 <br /> Please make Checks PAYABLE to : PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days atter the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> nIECEIVED <br /> Eta <br /> MAY S 2000 <br /> SAN JOAQUIN COUKfy <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5255.rpt <br />