Laserfiche WebLink
SAN JQAOUIN COWITY Page 1 <br /> ENVIRONNTtNTAL HEALTH DEPARTMO <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE <br /> Account ID AR0003673 <br /> <br /> <br /> <br /> <br /> <br /> <br /> STOCKTON, CA 95207 <br /> OWNER : `F )Se9'I RTHWE C <br /> Circle K Stores Inc. <br /> Health Amount <br /> uate Program Description <br /> Invoice# IN0104279—Date of invoice: 212712003 $ 200.00 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 285.00 <br /> 2/2712003 2244 2003 HMMP Annual Fee $ 10.00 <br /> 2/2712003 2301 UST STATE SURCHARGE $ 10.00 <br /> 2127/2003 2301 UST STATE SURCHARGE $ 10.00 <br /> 2/2712003 2301 UST STATE SURCHARGE $ 125.00 <br /> 2/2712003 2360 ADDITIONAL UST $ 125.00 <br /> 2/2712003 2360 ADDITIONAL UST $ 500.00 <br /> 212712003 2362 UST FACILITY&1 TANK $ 17.50 <br /> 2/2712003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br /> Total for this Invoice $ 1,282.50 <br /> Payment Due Date 3/2912003 <br /> TOTAL DUE this Billing Period =$ 1,282.50 <br /> PAYMENT <br /> RECEIVED <br /> MAR 2 1 2003 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penalties will be added to all Permit Fees Penalties will be added at the Rate of 10% <br /> at the Rate of 100%of the Base Fee 60 Days after the Invoice Date and each 30 Days thereafter <br /> 30 Days after the Due Date __j <br /> 5255.rpt <br />