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SAN J0A4U7N COUNTY PUBLICIPALTH SERVICES Report #5255 <br /> p N QNMENTAL HEALTHrDIVI N St ent Printed : 02/05/96 <br /> 041 WEBER AVENUE '- .-3RD FLOOR <br /> PO BOX 388 <br /> STOCKTON , CA 95201-0388 <br /> Accounting Office : 209 468-3420 <br /> J,:::p J. Y;:;C Ciro <br /> TO : CONNELL MOTOR TRUCK CO <br /> 2211 N WILSON WAY Account If 0003272 <br /> STOCKTON , CA 95208 <br /> ATTN : SHELDON HECKMAN Facility 0 003694 <br /> RE : RIVER CITY PETROLEUM CAROLOCK <br /> ._221.1 ._ N WILSON WAY . STOCKTON _ - <br /> PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br /> — Service Activity` <br /> Date Description Hrs Employee Amount <br /> Invoice N 026337 -- Date of Invoice: . 02/05/96 <br /> 02 /05/96 2301 UST State Surcharge Fee Tank # TA130405 $56 . 00 <br /> 02/05/96 2301 UST State Surcharge Ree Tank # TA130406 $56 . 00 <br /> 02 /05/96 2301 UST State Surcharge Fee Tank # TA130407 $56 . 00 <br /> - __ <br /> Total for this invoice : '168 . 00 <br /> If this INVOICE has been Paid, Please Disregard this Notice Payment DUE DATE. <br /> PAYMENT <br /> RECERYrri <br /> FEB 14 1996 <br /> PUJALNICOHEALTH SERCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PENALTIES for all FEES for SERVICE will be ASSESSED <br /> PENALTIES will be ASSESSED on all ANNUAL PERMITS at the rate of lot of the Service Fee <br /> at the rat# of loot of the Base Fee 30 days after the Payment DUE DATE <br /> 30 days after the Payment DUE DATE, and EACH 30 days thereafter. <br /> TOTAL DUE this Billing Period : X168 .00 <br /> Account I 1-30 Days 31-60 Days JL0 61-90 Daysl91�-120 Da�tsl 121+ Plus <br /> Summar y _.__ <br /> 168 . 00 0 . 00 0 . 00 0 . 00 0 . 00 <br /> a <br /> of <br />