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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME' <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0018042 <br /> Facility ID FA0011042 <br /> LMMMMMMMMMMME <br /> Date Printed F 1/30/2006 <br /> <br /> <br /> MANTECA, CA 95337 <br /> OWNER : ASH QADDOURA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143163—Date of Invoice: 1/27/2006 IIII III II I I I VIII V II VII VIII V I I I I I II I IIII V III III <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 3/112006 <br /> TOTAL DUE this Billing Period $ 224.00 <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 /> 5294 rpt <br />