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SAN JOAQUIN COUNTY PUBLIC HTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVIJPN • <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Amount ID AR0001456 <br /> Facility I FA0001457 <br /> Date Printed 4/24/00 <br /> PHILIP MATHEW RE: COLLEGEVILLE MARKET&CAFE* <br /> COLLEGEVILLE MARKET&CAFE* 13521 E MARIPOSA RD <br /> 13521 E MARIPOSA RD STOCKTON CA 95205 <br /> STOCKTON CA 95205 OWNER: LUKOSE,JOSEPH <br /> Health <br /> Date Program Description Firs Employee Amount <br /> Invoice# IN0069318---Date of Invoice : 4/19/00 <br /> 4/15/2000 9991 Credit Adjustment -$10.00 <br /> 4/19/2000 2301 UST STATE SURCHARGE $16.00 <br /> 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee Tank#006 $170.00 <br /> 4/19/2000 2360 Underground Storage Tank EH Operating Permit Fee Tank#007 $170.00 <br /> 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $356.00 <br /> Payment Due Date 5/24/2000 <br /> TOTAL DUE this Billing Period $356.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> atthe Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> r-"fiI'11 EN I <br /> FIF EIVED <br /> MAY -i= <br /> SAN Jr0A0UIN r 0UN i Y <br /> PUSUC HEALTH SERVICES <br /> Elute,;,UNMEMAL HEALTH DIVISiot, <br /> 5255.rpt • <br />