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SAN JO.AQUIN COUNTY • <br /> ENVIRONNIENTAL HEALTH DEPARTM T Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0003595 <br /> Facility ID I FA0003972 III <br /> Date Printed 1 1/30/2012 111 <br /> LAL, JOGINDER RE : SPIRIT GASOLINE* <br /> SPIRIT GASOLINE* / 1250 N WILSON WAY <br /> 1250 N WILSON WAY STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 1� <br /> OWNER : LAL, JOGINDER <br /> Date Health <br /> Prograrn Description Amount l <br /> I <br /> Invoice# IN0223887---Date of Invoice: 1/30/2012 11111111 111111 III VIII VIII VIII VIII 11111 VIII VIII VIII VIII VIII 1111111111 VIII IIII IIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 255.00 <br /> 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2012 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2012 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2012 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2012 2362 UST FACILITY&1 TANK $ 550.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> Total for this Invoice 1 $ 1,362.00 <br /> Payment Due Date 2/29/2012 <br /> TOTAL DUE this Billing Period $ 1,362.00 <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 />