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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTJWT • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0026446 <br /> Facility ID FA0015353 <br /> Date Printed 5/17/2004 <br /> Immmomommummomm <br /> BENNY,VICTOR RE : BENNY PROPERTY <br /> 1154 SECRET LAKE LOOP 226 MYLAR <br /> LINCOLN, CA 95648 MANTECA, CA 95336 <br /> OWNER : BENNY, VICTOR <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0119470--Date of Invoice: 4/28/2004 IIIIIIIIIIIIIIIIIIIIIIII I�IIIIIIIIIIIIIII <br /> Hrs Employee <br /> 4/23/2004 2304 034-UST PERM CLOSURE PLAN CHECK 0.50 CATANYAG $ 46.50 <br /> 4/28/2004 9999 PAYMENT ($ 279.00) <br /> 4/29/2004 2304 134-UST REMOVAL INSPECTION 2.50 CATANYAG $ 232.50 <br /> 5/14/2004 2304 034-UST PERM CLOSURE PLAN CHECK 1.00 VON FLUE $ 93.00 <br /> Total for this Invoice $ 93.00 <br /> Payment Due Date 6/16/2004 <br /> Invoice# IN0119805---Date of Invoice: 5/17/2004 <br /> 5/17/2004 2300 UNDERGROUND TANK PROGRAM $ 170.00 <br /> 5/17/2004 2300 UNDERGROUND TANK PROGRAM $ 500.00 <br /> 5/17/2004 2300 UNDERGROUND TANK PROGRAM S 170.00 <br /> 5/17/2004 2300 UNDERGROUND TANK PROGRAM $ 500.00 <br /> 5/17/2004 2300 UNDERGROUND TANK PROGRAM $ 500.00 <br /> 5/17/2004 2300 UNDERGROUND TANK PROGRAM $ 500.00 <br /> 5/17/2004 2301 UST STATE SURCHARGE $ 15.00 <br /> 5/17/2004 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> 5/17/2004 9001 BACK FEES AND/OR PENALTIES $ 500.00 <br /> 5/17/2004 9001 BACK FEES AND/OR PENALTIES $ 500.00 <br /> 5/17/2004 9001 BACK FEES AND/OR PENALTIES $ 170.00 <br /> 5/17/2004 9001 BACK FEES AND/OR PENALTIES $ 170.00 <br /> 5/17/2004 9001 BACK FEES AND/OR PENALTIES $ 500.00 <br /> 5/17/2004 9001 BACK FEES AND/OR PENALTIES $ 500.00 <br /> Total for this Invoice $ 4,719.00 <br /> Payment Due Date 6/16/2004 <br /> TOTAL DUE this Billing Period $ 4,812.00 <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 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 />