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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1863 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 Fc;F—wE <br /> A <br /> AccountlD R0029524 <br /> INVOICE _ <br /> Facility ID FA0016663 <br /> Date Printed 2/2/2016 <br /> FUEL DELIVERY SERVICES RE : FUEL DELIVERY SERVICES <br /> <br /> STOCKTON, CA 95206 <br /> OWNER : VAN DE POL ENTERPRISES INC. <br /> Date Health <br /> i <br /> Prnnram Description Amount <br /> Invoice# IN0275792---Date of Invoice: 2/2/2016 (IIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII 1111 <br /> IIII IIIIII VIII IIII IIII <br /> 2/2/2016 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> 2/2/2016 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 675.00 <br /> 2/2/2016 APSA APSA SURCHARGE $ 26.00 <br /> Total for this Invoice $ 736.00 <br /> Payment Due Date 3/3/2016 <br /> TOTAL DUE this Billing Period $ 736.00 <br /> EGLIVED <br /> FEB 17 2016 <br /> ENVIRONMENTAL <br /> I-11=.A I TW r1>=04 RTfVFNT <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 HMBP 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 /> 5254.rpt <br />