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JAry JUAUUIN I.UUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0009105 <br /> Facility ID FA0006423 <br /> Date Printed 1/28/2005 <br /> LEE,JEAN HYUN RE : UNITED GAS <br /> UNITED GAS 3440 E MAIN ST <br /> 3440 E MAIN ST STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 <br /> OWNER : LEE, JEAN HYUN <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0128722--Date of Invoice: 1/24/2005 11111111 IIIIII III IIIII IIIII VIII IIIII IIIII IIIII IIIII IIIII IIIII VIII IIII IIIIII IIIII IIII IIII <br /> 1/24/2005 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 85.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2301 UST STATE SURCHARGE $ 15.00 <br /> 1/24/2005 2360 ADDITIONAL UST $ 125.00 <br /> 1/24/2005 2360 ADDITIONAL UST $ 125.00 <br /> 1/24/2005 2362 UST FACILITY 81 TANK $ 500.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this invoice $ 1,104.00 <br /> Payment Due Date 2/2312005 <br /> TOTAL DUE this Billing Periocil 1,104.00 <br /> /. <br /> PMM N-T <br /> RF-cE <br /> F Eg 2 4 2005 <br /> SAENVIVljo' ENT.L <br /> H�,LTN DEPARTMENT <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 DES/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 /> 5255.rpt <br />