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*AN JOAQUIN COUNTY PUBLIC I TH SERVICES Page 1 <br /> r ENVIRONMENTAL HEALTH DIVIWN <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0004672 <br /> Facility ID FA0002602 <br /> VOINNIMMENNIMMMOM <br /> Date Printed 4/16/01 <br /> RE : KAISER PERMANENTE <br /> KAISER PERMANENTE 7373 WEST LN <br /> 7373 WEST LN STOCKTON CA 95210 <br /> STOCKTON CA 95210 OWNER: KAISER PERMANENTE <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0079367--Date of Invoice: 1130/01 <br /> 3/15/2001 9991 Credit Adjustment -$550.00 <br /> 1/30/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2362 Underground Storage Tank EH Operating Permit Fee Tank#001 $500.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $68.00 <br /> Payment Due Date 3/2l 01 <br /> TOTAL DUE this Billing Period 68. <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 after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMENT <br /> RECEIVED <br /> APR 1 6 2001 <br /> SANJO'C' cG1_;Nry <br /> PU31 lc ili I f.=!!'vas <br /> 5255.rpt <br />